June 2, 2011

Key Terms in Palliative Care and Pain Treatment

Essential medicine: A medicine included in the World Health Organization’s Model List of Essential Medicines.

Palliative care: Health care that aims to improve the quality of life of people facing life-limiting illnesses, through pain and symptom relief, and through psychosocial support for patients and their families. Palliative care can be delivered in tandem with curative treatment but its purpose is to care, not to cure.

Life-limiting illness: A broad range of conditions in which painful or distressing symptoms occur; although there may also be periods of healthy activity, there is usually at least a possibility of premature death.

Hospice: A specialist medical facility that provides palliative care. Hospices can be residential or outpatient facilities.

Chronic pain: As used in this report, pain that occurs over weeks, months, or years, rather than a few hours or a few days. Because of its duration, moderate to severe chronic pain should be treated with oral opioids rather than repeated injections, especially for children and people who are emaciated by diseases such as cancer and HIV/AIDS.

Opioid : Drugs derived from the opium poppy and similar synthetic drugs. All strong pain medicines, including morphine and pethidine, are opioids. Weaker opioids include codeine and tramadol.

Morphine: A strong opioid medicine, the gold standard for treatment of moderate to severe pain. Morphine is considered an essential medicine by the World Health Organization in its injectable, tablet, and oral solution formulations. Oral solution mixed from morphine powder is the cheapest formulation.

Basic pain medicines: Non-opioid pain medicines suitable for mild pain. These include paracetamol (also known as acetaminophen), aspirin, diclofenac, and ibuprofen.

Opioid dependence: Physical dependence experienced by a patient treated with opioids over time, such that withdrawal symptoms occur if the opioid is stopped abruptly. Physical dependence is treated by gradually reducing the opioid dose. It is distinct from addiction, a pattern of behaviors including compulsive use of drugs despite harm, which is uncommon in patients receiving opioid pain treatment.

Primary healthcare facility: A medical facility that a patient will usually attend first in a non-emergency situation, such as a clinic or healthcare center. Many patients globally only have access to primary-level health care.

Tertiary hospital: A large hospital at the peak of a hierarchy of hospitals. A tertiary hospital provides all of the major medical services available in a country and admits patients referred from smaller hospitals that provide fewer services.