How can I assess and manage pain effectively in patients during the last days of life?

Effective assessment and management of pain in patients during the last days of life involves several key steps. First, assess the patient's level of pain and identify all possible causes, including reversible ones such as urinary retention, to guide appropriate treatment decisions.

Use validated behavioural pain assessment tools for patients unable to communicate effectively, such as those with dementia or learning disabilities.

Manage pain promptly and effectively by matching the choice of analgesic to the severity of pain and considering the patient's preferences for administration routes.

Consider non-pharmacological methods such as repositioning to alleviate pain alongside pharmacological treatments.

When prescribing medicines, start with the lowest effective dose and titrate as needed, regularly reassessing symptoms at least daily to adjust treatment appropriately.

Choose the most suitable route for medication administration based on the patient's condition and ability to swallow, preferring subcutaneous or intravenous routes over intramuscular injections if oral administration is not possible.

If more than 2 or 3 doses of 'as required' medicines are needed within 24 hours, consider using a syringe pump for continuous symptom control.

Stop any medicines that do not provide symptomatic benefit or may cause harm after discussion with the patient and those important to them.

Seek specialist palliative care advice if symptoms do not improve promptly or if there are undesirable side effects such as unwanted sedation.