Clinical Review

ABC of palliative care: Non-malignant conditions

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7127.286 (Published 24 January 1998) Cite this as: BMJ 1998;316:286
  1. Tony O'Brien,
  2. John Welsh,
  3. Francis G Dunn

    Much medical practice is still concerned with control of symptoms rather than cure, and doctors spend considerable time palliating and modifying symptoms associated with incurable disease.

    A strong body of opinion argues that the skills and philosophies of palliative care should be extended to all care settings. This is optimally delivered by those working in their own specialty—such as neurology, cardiology, and respiratory medicine. Training in basic palliative care should form part of the undergraduate and postgraduate curricula for healthcare professionals. The success and relevance of palliative care will be judged not by the number of specialist teams but by the capacity to influence the care offered to all patients irrespective of diagnosis and place of care

    The role of specialists in palliative medicine is to offer what has been learnt about palliation of malignant disease to those caring for patients with progressive, incurable, non-malignant conditions and to share and exchange best practice. Many symptoms experienced by cancer and non-cancer patients are similar: cancer patients' symptoms may be more severe, but those of non-cancer patients tend to be more prolonged.

    Symptoms common to malignant and non-malignant conditions

    Physical
    • Pain

    • Breathlessness

    • Anorexia

    • Immobility

    • Constipation

    Social
    • Loss of employment

    • Role change

    • Fear for dependants

    Psychological
    • Depression

    • Fear and anxiety

    • Uncertainty

    • Guilt

    Existential
    • Religious

    • Non-religious

    • Meaning of life

    • Why?

    The approach to controlling pain in progressive non-malignant conditions can be adopted from the strategy for managing cancer related pain. After an accurate diagnosis of the pain, appropriate treatment can be started: the principles of the World Health Organisation's analgesic ladder (discussed in the first article of this series) apply equally to non-cancer patients. The strength of analgesia chosen depends on the severity of the pain, and the choice of adjuvant analgesic depends on the pathogenesis of the pain.

    Doctors may be concerned about giving opioids to patients with chronic non-malignant pain. This is a …

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