title: Pain management in a patient with renal and hepatic dysfunction.
abstract: BACKGROUND
  Palliative medicine providers are often consulted to provide guidance for pain relief for a diverse population. End-of-life care is often challenging, balancing optimum pain relief with minimal side effects. Patients with both renal and hepatic dysfunction are particularly challenging when considering appropriate treatments.
  
  
  CONCLUSIONS
  This case discussion highlights an end-of-life pain symptom management challenge, and the associated pharmacological background. Ultimately, with no ideal pharmaceutical option, individualization of therapy will be crucial. Collaboration of palliative medicine providers and pharmacists may concurrently provide the best possible care at the best possible time and in the optimal location.
authors.affiliation: 1 Adult Palliative Medicine Service, Multicare Health System, Tacoma General Hospital , Tacoma, Washington.
authors.forename: David B
authors.initials: DB
authors.lastname: Brecher
authors.forename: Tasheba L
authors.initials: TL
authors.lastname: West
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000378:metabolism*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care; D051437:Renal Insufficiency / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid