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Pharmacology of Pain Management at the End-of-Life: Association Between Pain, Anxiety, Delirium and Sleep Disorders in Terminally ill Patients
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Assessment and management of pain at the end of life is a manifold issue with a deep impact on the patient's quality of life. With a better understanding of pain management's key principles at the end of life, caregivers can contribute to providing comfort and solace to their dying patients. 

Studies of dying patients reveal that up to 57 percent describe moderate or severe pain in the last month of life and 23 percent experience uncontrolled pain in the last week of life.  Untreated pain can be devastating to the patient and family or other loved ones not only because of the suffering it produces, but also because it interferes with the ability to complete important tasks at the end of life.  Pain management at the end of life is a right of the patient and the duty of the clinician.  

A key element to achieving satisfactory pain relief for the patient at the end of life is knowledge of pain reduction medications.  Failure to treat pain effectively can result from a lack of clinician training regarding end-of-life care or from the fear of violating ethical, moral, and legal tenets in the administration of pain medication to the dying patient. Clinicians may have an exaggerated misperception of the risk of hastening death when treating patients with opioids. Furthermore, some clinicians may be unclear about the clear associations between sedation for intractable pain, anxiety, delirium and sleep disturbances at the end of life as they relate to pain management.  

This presentation will highlight the latest pharmacologic modalities to treat pain at the end of life.  In addition to discussing the pharmacology of opioids, we will also state the importance of NSAIDS, benzodiazepines, antidepressants, hypnotics and anticonvulsants in pain management.  The importance of drug-drug interactions and organ failure with regards to end-of-life pharmacology will be highlighted. 14

Paul Langlois, APN, PhD, CCRN, CCNS

Paul Langlois, APN, PhD, CCRN, CCNS, is a critical care clinical specialist in the surgical, medical, neurologic, burn, CCU, and trauma ICUs of Cook County Hospital, Chicago. Drawing on over 40 years of experience assessing and managing patients with life-threatening diseases, Dr. Langlois provides advanced-level training to nurses, physician assistants, nurse practitioners, respiratory therapists, and physicians.

Dr. Langlois is committed to providing the highest quality of care to patients through advanced education. His presentations are evidence-based, timely, and provide participants with numerous case studies to facilitate critical thinking. As a bedside clinical nurse specialist, he has developed several institution-wide protocols for the multidisciplinary assessment and management of infectious disease and multi-system organ failure patients.

His presentations are enthusiastically delivered and offer highly practical tips that help make the most challenging concepts easy to understand. Linking knowledge to clinical practice is the goal of every educational program.  


Speaker Disclosures:
Financial: Paul Langlois has employment relationships with Cook County Hospital and Emergency Care Consultants. He receives a speaking honorarium and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Paul Langlois is a member of the American Nurses Association and the American Association of Critical Care Nurses.



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