Palliative sedation is the use of sedating medications in progressive doses until a desired level of sedation is achieved.  It's only used as a last resort when someone is suffering at the end of life and nothing else is working to relieve it.  The New York Times has just covered this topic, bringing awareness of a little known palliative care method to the spotlight.

I've seen palliative sedation work wonders.  One of my first hospice patients years ago was a young woman in her 40's suffering of metestatic ovarian cancer.  She was in so much pain and agony that her teenage son had to leave the house and stay with friends.  He couldn't bear to see his mother  writhe and cry out in agony.  Her boyfriend was at a loss as well.  He was the only one who could stay with her and provide her care but the emotional impact of watching her suffer was almost more than he could bear.

We tried using high doses of intravenous (IV) pain medications and even those weren't touching the pain.  When we offered to administer medication that would put her in a coma-like state, she pleaded and cried to be put out of her misery.  Her boyfriend was relieved as well.  Her son came home and had a few minutes to be with his mother before she slipped into unconsciousness.

I started the medications and within minutes she fell into a deep and painless slumber.  Her face, once twisted and contorted in pain, was peaceful and relaxed.  Her son sat by her bedside for the next four days, holding her hand and saying everything he'd been wanting to say but couldn't when she was in pain.  Her boyfriend was able to focus on lovingly caring for her during her last days.  Palliative sedation offered this family quality time to express their love and gratitude and a much needed rest from pain and suffering.

Learn more about Palliative Sedation and find out Does Palliative Sedation Cause Death?

Read the full New York Times Article "Hard Choice for a Comfortable Death:  Sedation"

As much as I'm dreaming of a white Christmas back on the east coast (and it is really white there right now!) I counting my lucky stars that I don't have to deal with the headache of holiday travel.  The same isn't true for thousands of travelers this week; it's a crazy busy week of travel as people rush to be with their loved ones or  escape to a tropical island somewhere (that sounds pretty good right now!)

If you're a hospice patient or will be traveling with a patient, your hectic holiday travel can turn into a full-blown nightmare if you don't plan ahead.  Before you head out on your journey, cover your bases with my holiday travel tips.

10 Travel Tips for Patients

Tips for Traveling With Oxygen

A study published in the Journal of Pain and Symptom Management showed that patients using a cannabinoid oral spray reduced their cancer pain by 30%.  The study was a double-blind, randomized, placebo-controlled study of the efficacy of the tetrahydrocannabinol:cannabidiol (THC:CBD) extract (oral spray) versus standard THC extract and placebo at treating intractable cancer pain - pain that is not well controlled despite opiod pain medication.  The THC:CBD spray reduced pain by 30%, the THC and placebo showed nonsignificant change in pain level.

The THC:CBD extract, marketed under the name Sativex, is already approved in Canada for the treatment of cancer pain and multiple sclerosis and is pending approval in Great Britain and the European Union.  The authors of the study have said about the THC:CBD spray:

"... the THC/CBD extract showed a more promising efficacy profile than the THC extract alone. This finding is supported by evidence of additional synergy between THC and CBD. CBD may enhance the analgesic potential of THC by means of potent inverse agonism at CB2 receptors, which may produce anti-inflammatory effects, along with its ability to inhibit immune cell migration. ... These results are very encouraging and merit further study."

The United States authorized a clinical trial to assess the efficacy of Sativex in 2006 and results from that study are expected to be reported in the spring of 2010.

Read more about pain management, including the medicinal use of marijuana for symptom management.

Most palliative care patients with chronic pain have been prescribed around-the-clock pain medication.  Reason tells us that if the patient is taking something around-the-clock then they should also be prescribed something for breakthrough pain - just in-case.   Breakthrough pain is the pain that "breaks through" regularly schedules doses of pain medication.  Unfortunately, medication isn't always prescribed for breakthrough pain and patients don't always take as much as they are allowed.

Breakthrough pain is almost always treatable and shouldn't be ignored or accepted as and "inevitable" part of illness.  Learn how to recognize breakthrough pain, what could be causing it, and how you can help treat it.

Managing Breakthrough Pain