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A Hospice Physician's Perspective on Medications for the Relief of Pain and Suffering

Pain Multiple therapeutic options exist for the treatment of severe pain. Pain is extremely complex, and our understanding of how to treat various types of pain is constantly evolving. A discussion on all the various types of pain and the specific methods for treating them is beyond the scope of this article. In broad terms, hospice patients tend to suffer from one or more types of pain, often at the same time. These types of pain include acute, chronic, nociceptive (both visceral and somatic), and neuropathic pain. This report focuses on one of the most important medications available to us in the treatment of pain: morphine. The mainstay for the treatment of moderate to severe pain at the end of life consists of the opiate medications. Choices include morphine (e.g., Roxanol), fentanyl (e.g. Duragesic, Actiq), oxycodone (e.g., Percocet, OxyContin), and hydromorphone (Dilaudid). All these are excellent medications for the treatment of severe pain. Although these medications all are from the same drug class, they have characteristics that separate them. Certain properties and availability in various forms make some of these medications more useful than others at the end of life. Consequently, for patients at the end of life, we tend to use some medications more than others. For moderate to severe pain, morphine may be the drug of choice. The benefits of morphine for pain management at the end of life separate it from other choices because