**3.4 Pain services**

The pain services as special teams working on pain treatment takes place in or out of the Hospices. They could practice pain treatment as "patronage services",

**227**

**Figure 1.**

*drugs; PCA- patient control analgesia).*

*Multimodal Pain Management in the Setting of Palliative Care*

visiting the homes of persons at the end of their life or patients with cancer pain. The goal of such services is to achieve the best care and to improve the life for

In normal conditions, the primary analgesic management in palliative care starts with *oral administration of the medicines.* The WHO in 1986, for nociception pain, proposed a "step by step" approach which understands escalation of the drugs from

Primarily the ladder approach was used for cancer pain, but today it is widely used for any kind of pain. In 2010, Vargas-Schaffer G. suggested a re-adapted four steps ladder [35] (**Figure 1**), which in 2012 was revised by Leung, who advised pain treatment in a tridimensional multimodal platform [36], and at list, in 2019 Cuomo

The administration of drugs in palliative care is recommended to be less invasive. When possible, the most appropriate method is oral administration. Also, among less invasive methods well accepted by the patients are rectal or transdermal (patches) application. When it is necessary to apply the invasive parenteral routes, intra venous (IV), intramuscular (IM), subcutaneous (SC), can be considered. Dosing is different and varies depending on the type of the pain from around-the-clock dosing, "as-

Non –opioids are a group of medications consisting of anti-inflammatory and non-steroidal anti-inflammatory drugs. They have antipyretic, anti-inflammatory, and anti-platelet effects. Their use in palliative care takes an eminent place because most of the etiological factors of the pain are related to inflammation. Traditionally they include anti-inflammatory drugs such as salicylic acid, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which remain the major players for the treatment of pain in PC [38]. They have an opioid sparing effect when used in

*Readapted WHO ladder for analgesic management [22]. (legend: NSAIDs- non-steroidal anti-inflammatory* 

**4. Pharmacotherapy in pain management in palliative setting**

introduced the trolley model for multimodal tailored therapy [37].

needed dosing" to "patient-controlled analgesia (PCA)".

multimodal therapeutic approach (see below).

*DOI: http://dx.doi.org/10.5772/intechopen.96579*

non-opioid to opioid analgesics [34].

patients and their families.

**4.1 Non-opioids**

visiting the homes of persons at the end of their life or patients with cancer pain. The goal of such services is to achieve the best care and to improve the life for patients and their families.
