Pearls offered for end-of-life pain treatment.(Neurology)

SAN FRANCISCO -- Opioids are the mainstay of pain treatment at the end of life, but using them in this population presents some challenges, Janet L. Abrahm, M.D., said at the annual meeting of the American College of Physicians.

Dr. Abrahm, codirector of the pain and palliative care program at the Dana-Farber Cancer Institute, Boston, offered a series of pearls on the topic:

* Chronic pain doesn't look like acute pain. A person in chronic, severe pain may not have any objective, observable signs. You have to believe the patient, and be alert for behavioral signs. For example, people in pain often guard the painful part of their bodies. They don't eat, sleep, or interact normally.

* Don't forget nonpharmacologic therapies. Heat, cold, and massage can all be helpful. Cold seems to work especially well with neuropathic pain. Have a family member fill a foam cup with water, freeze it, and give the patient an ice massage. Heat works well if there's a muscle spasm.

Positioning the patient properly is also important. Help patients take their limbs off …