title: A peaceful death: how to manage pain and provide quality care. A roundtable discussion: Part 2.
abstract: One of the most important components of a peaceful death is adequate control of pain and other distressing symptoms, such as dyspnea, agitation, and restlessness. Pain is an important symptom in 75 to 80% of noncancer patients in the last year of life. Opioid analgesics are often the mainstay of pain treatment for dying patients. A primary care physician also needs to know about anesthetic and neurosurgical approaches, the use of cognitive behavioral approaches, and the availability of specialized pain experts. A sizeable minority of physicians receive requests for an assisted death, which should be seen as a cry for help. The most useful function of advance directives is that they open an avenue for discussion between the doctor and the patient about a difficult subject.
authors.affiliation: Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Butler
authors.forename: R
authors.initials: R
authors.lastname: Burt
authors.forename: K M
authors.initials: KM
authors.lastname: Foley
authors.forename: J
authors.initials: J
authors.lastname: Morris
authors.forename: R S
authors.initials: RS
authors.lastname: Morrison
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D017236:Suicide, Assisted
chemical_list: D000701:Analgesics, Opioid