Adult Cancer Pain: Part 2 -- The Latest Guidelines for Pain Management

Laura A. Stokowski, RN, MS

Disclosures

December 06, 2010

In This Article

Palliative Sedation

Palliative sedation is the use of controlled, continuous sedation for the management of refractory symptoms in patients with cancer who are undergoing palliative care.[7]Research shows that palliative sedation does not necessarily shorten life in terminally ill patients.[7]

Previous NCCN pain guidelines did not address the strategy of palliative sedation in the management of adult cancer pain. In NCCN v. 2010, the concept was introduced with the statement, "Consider palliative sedation for intractable pain."

Judith Paice explains the rationale for adding palliative sedation as a pain management option. "We are acknowledging that there are times that we can't manage a patient’s pain well, times that call for more intensive measures. We recommend that clinicians get a palliative care consult so that the oncology team has the kind of specialty support needed to ensure that the decision is made carefully, that the family has given their consent. Palliative sedation is not euthanasia, it doesn't advance the patient's disease or the progression towards death. It is an important therapy that is used minimally in those very complicated circumstances when all available treatments fail to get the patient's pain under control. It's fairly new to oncology, although it has been used for some time in palliative care settings."

Paice tells of a recent situation in which palliative care was used. "We had a patient with multiple myeloma, very progressive and widespread disease. He had bony lesions throughout his body. He was on high doses of opioids, but developed a neurotoxic effect -- myoclonus -- and it was clear the jerking movements were increasing the pain of the bony lesions. We tried, unsuccessfully, to switch his opioids, as well as several other aggressive therapies. With his consent, and his family's, we sedated him. We were able to lighten up his sedation temporarily when family members came in from out of town to see him, and then we resumed it.

Palliative sedation was difficult for staff nurses and the family. Everyone needed a lot of support. It was hard for the family to watch him. It was as if he were in a coma, still alive, but not responding."

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