Managing pain in the dying patient

End-of-life care can be a challenge requiring the full range of a family ph ysician's skills. Significant pain is common but is often undertreated desp ite available medications and technology. Starting with an appropriate asse ssment and following recommended guidelines on the use of analgesics, famil y physicians can achieve successful pain relief in nearly 90 percent of dyi ng patients. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to al leviate pain. Anticonvulsants can be especially useful in relieving neuropa thic pain. Side effects of pain medications should be anticipated and treat ed promptly, but good pain control should be maintained. The physical, psyc hologic, social and spiritual needs of dying patients are best managed with a team approach. Home visits can provide comfort and facilitate the doctor -patient relationship at the end of life.