What Does a Palliative Doctor Do?

Medical Treatments

There are many types of pain relief and many methods for providing pain relievers, including by mouth, through suppositories, via patches or through a tube inserted in a blood vessel or injected under the skin. You may be given a pump that allows you to control the amount of pain medicine you receive. Some of the medical options, which may be provided alone or in combination with others, include:

• Opioids – such as morphine, oxycodone, hydromorphone, methadone, fentanyl, meperidine, codeine, hydrocodone and propoxyphene
• Other pain medicines – such as nonsteroidal anti-inflammatories (NSAIDs) – including naproxen, celecoxib and ibuprofen – tricyclic antidepressants, anticonvulsants, N-methyl D-aspartate receptor antagonists, anesthetics, alpha-2 agonists, anticholinergics
• Other pain relievers – such as nerve blocks, spinal infusions, surgery and radiation therapy

Pain is not the only symptom of a serious illness. You may be suffering from shortness of breath, constipation, anxiety, loss of appetite or other symptoms. But as with pain, there are many, many ways to find relief from these and other symptoms. Following are some of the most common symptoms of serious illness and remedies that you may be able to try or that a palliative doctor can discuss with you.

• Shortness of breath – Change to a more upright position, open windows, use a fan, humidifier or air conditioning, avoid strong odors, identify triggers that cause the problem and eliminate them.
• Nausea and vomiting – Avoid disagreeable foods and odors, fatty and fried foods, take most medications after eating, suck on a mint or hard candy, eat small, frequent meals and use relaxation techniques.
• Constipation – Certain foods and beverages, such as prune juice can help, but medical treatment is likely the best option.
• Disorientation or delirium – This very common symptom can be prompted by medications, infection or organ failure at the end of life, and is best treated by a doctor. To help, loved ones can use soft reassuring voices, keep noise to a minimum and avoid night disruptions.
• Loss of appetite – Reasons for loss of appetite are many and the doctor can suggest the best options for treatment. Loss of appetite is normal at the end of life and does not mean the person is starving – people can live comfortably for a long time on very little food, and placement of an artificial feeding tube sometimes can shorten life. Things that sometimes can increase the appetite include being involved in menu planning, lifting dietary restrictions (such as low-salt or cholesterol), eating small portions of a favorite food, avoiding food with strong orders and eating easy-to-swallow foods, such as pudding or pureed food.
• Depression and anxiety – Some depression and anxiety are normal in serious illness. Family members can help by providing updates on treatments and outlook, communicating openly and honesty, helping renew a sense of self-worth and meaning, establishing short-term goals, focusing on strengths as well as encouraging the keeping of a journal, exercise, using relaxation techniques and doing other activities that can distract from depression and anxiety. Excessive depression and anxiety can be treated through medication and counseling.

Again, combinations of medications and other treatments may be used. Your palliative doctor has received special training and therefore has the expertise to devise a safe and effective pain and symptom treatment plan.