Priority 19 from the Palliative and end of life care PSP

UNCERTAINTY: What are the best ways to make sure that palliative care patients receive adequate pain and symptom relief and which drugs for pain management are best in terms of side-effects, such as drowsiness? What are the best approaches to giving medicines such as morphine, for example using different cannulas, such as BD-saf-T-intima? (JLA PSP Priority 19)
Overall ranking	19
JLA question ID	0026/19
Evidence	Bell RF, Eccleston C, Kalso EA. Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD003351. DOI: 10.1002/14651858.CD003351.pub2. Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD011056. DOI: 10.1002/14651858.CD011056.pub2. Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003868. DOI: 10.1002/14651858.CD003868.pub3. Ongoing trials: Switching From Morphine to Oral Methadone Plus Acetaminophen in the Treatment of Cancer Pain: A Randomized, Double-Blind Study NCT00525967 IMPACCT: exploratory study of a community pharmacy pain medicines consultation for patients with cancer pain ISRCTN14670659 Effect of therapeutic touch on pain and anxiety in patients with cancer http://www.irct.ir/searchresult.php?id=4115&number=3
Health Research Classification System category	Generic

Extra information provided by this PSP
Original uncertainty examples	Are there any painkillers that can make a person more comfortable but not make them so drowsy? ~ What is best / common practice with pain management? ~ The questions that need an answer are mainly about how pain will be relieved and how it can be achieved.
Submitted by	Bereaved Carers x 6 ~ Carers x 2 ~ Professionals x 6 ~
Outcomes to be measured	Change in symptoms; change in management of symptoms; counselling and advice; GP visits; 24-hour support, for patients, carers and families; patient Satisfaction; health related quality of life; health related cost.

PSP information
PSP unique ID	0026
PSP name	Palliative and end of life care
Total number of uncertainties identified by this PSP.	83 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 November 2014