Treatment options to manage pain at the end of life.

Experts believe that the time preceding death can be comfortable if people die without pain, with dignity, and in their own way. Given current analgesic options, psychological and spiritual interventions, and an effective health care delivery system, all these goals are achievable. Pain management is one of the most important aspects of end-of-life care. Effective analgesics should be chosen carefully, in keeping with the patient's overall condition, level and stability of pain, and specific patient/family wishes. Ideally, analgesics should be initiated as soon as appropriate. The variety of routes of delivery, ranging from oral to transdermal or epidural to intrathecal, allows a selection that will achieve comfort and yet be least troublesome for the caregiver and patient. As the palliative care specialty continues to grow in the United States, it is imperative that health care professionals in the field develop basic to advanced primers to assist in equipping colleagues in all specialties with an understanding of effective opioid use, as well as the multidimensional aspects of helping patients achieve comfort at the end of life.