title: [The hospice approach to pain and problems in home palliative care].
abstract: Author points to principles upon which not only the control of pain but also of all other symptoms depends: an appreciation of symptoms as a psychosomatic phenomenon, an accurate diagnosis of the cause of the symptom and in reference to pain application of the World Health Organisation's Analgesic Ladder for Cancer Pain. He takes these principles for granted and elaborates on the use of drugs and to lesser extent, other techniques which are used in hospice practise. Morphine is metabolised into M6G i M3G, the first being significantly more potent an analgesic as morphine. Its late and prolonged presence is probably basic for continuous morphine application instead of "as required" way. Author is giving very precise recommendations for per os and parenteral dose titration, discussing the side-effects and data about the related drugs, the analgesia in neuropathic pain and the special techniques like radiation, nerve blocks and epidural analgesia. Speaking about the palliative home care problems the author explains the most important factors enabling a family to continue their care at home. The author keeps discussing the poor appetite, vomiting, dysphagia, constipation. Respiratory problems are elaborated with more details especially those in "death rattle", with the optimal drug option recommendation, and many technical details.
authors.affiliation: Hospicij Sv. Kristofora, London.
authors.forename: N
authors.initials: N
authors.lastname: Sykes
mesh_terms: D006701:Home Nursing; D017051:Hospice Care; D006801:Humans; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care
vernacular_title: O hospicijskom pristupu boli i problemima kućne palijativne skrbi.