The nurse is providing care to Mr X who is admitted in a palliative care unit. The main strategy used in palliative care to manage pain is ______.

1. A

   Acetaminophen

2. B

   Diazepam

3. C

   Gabapentin

4. D

   Morphine

Appeared in: GMCH Nursing Officer-2025

Explanation

• Morphine is a strong opioid, which is the recommended first-line treatment for moderate to severe pain according to the World Health Organization (WHO) analgesic ladder.
• In palliative care, the goal is to control pain effectively to improve the patient's quality of life, and opioids are the most potent class of analgesics for this purpose.
• Unlike non-opioids, morphine does not have a 'ceiling effect,' meaning its dose can be increased as needed to manage escalating pain.
• It is the prototype drug against which other opioids are measured and is considered the gold standard for severe cancer-related pain.

Why Other Options Were Wrong

• Option A: Acetaminophen is a non-opioid analgesic used for mild to moderate pain. It is often used as an adjunct but is not potent enough to be the main strategy for the severe pain frequently encountered in palliative care.
• Option B: Diazepam is a benzodiazepine, not an analgesic. Its primary uses are for anxiety, muscle spasms, and seizures. While it may be used in palliative care for these symptoms, it does not treat pain itself.
• Option C: Gabapentin is an adjuvant analgesic, primarily used for neuropathic pain (e.g., burning, tingling, or shooting pain). While it is a key part of pain management for patients with nerve-related pain, it is not the main overall strategy for all types of pain (like nociceptive pain) in palliative care.

Related Visual

• Visual 1: Diagram - The WHO three-step analgesic ladder, illustrating the progression from non-opioids for mild pain, to weak opioids for moderate pain, and finally to strong opioids for severe pain.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacological Pain Management in Palliative Care to guide bedside assessment, documentation, and the next nursing action.
• A core nursing responsibility in palliative care is accurate pain assessment and advocating for effective, timely pain management to ensure patient comfort and dignity.
• Nurses must proactively manage opioid side effects, especially constipation. An order for a bowel regimen should be obtained when starting opioids to prevent severe discomfort and potential impaction.
• Patient and family education is crucial to address fears and misconceptions about opioid use, such as addiction (which is rare when used for legitimate pain) and respiratory depression (which is manageable with careful titration).

How to Approach the Question

• First, identify the clinical context of the question: 'palliative care unit'. This setting implies a focus on symptom management and quality of life, often for patients with serious, life-limiting illnesses.
• Next, identify the core concept: 'main strategy' for 'pain management'. This asks for the primary or most important pharmacological approach.
• Recall the standard framework for cancer and palliative pain management: the WHO three-step analgesic ladder.
• Evaluate the options based on the WHO ladder. Acetaminophen is for mild pain (Step 1). Gabapentin is an adjuvant. Diazepam is not an analgesic. Morphine is a strong opioid for severe pain (Step 3).
• Conclude that for the significant pain often present in palliative care, a strong opioid like morphine represents the main strategy.

Concept Tested & Keywords

• Concept Tested: Pharmacological Pain Management in Palliative Care
• Stem keywords: palliative care, pain management, main strategy
• Lead-in keywords: main strategy

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QIrNDJW9w2f3jFT5CGzukA

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