Managing the Side Effects of Pain Medications in Palliative Care

Pain management is a critical part of palliative care, improving quality of life for patients with serious illnesses. While pharmacologic interventions are often necessary for controlling pain, they come with potential side effects that can significantly affect a patient’s comfort and well-being.

To ensure effective and compassionate care, nurses need to have a good understanding of the potential side effects and how they can be addressed, whether that’s by patient and caregiver education delivered by the nurse or through medical adjustment by the prescribing physician.

The Balancing Act: Effectiveness Versus Side Effects

Pain management in palliative care often requires the use of potent medications, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant therapies.1 While these medications can be highly effective in controlling pain, their side effects can pose significant challenges. For instance, opioids are frequently associated with constipation, nausea, sedation, and respiratory depression. NSAIDs can lead to gastrointestinal issues, renal impairment, and increased risk of cardiovascular events, particularly with long-term use. Adjuvant medications, while useful for enhancing pain relief and managing specific pain types, also carry their own set of potential side effects, such as drowsiness, dizziness, and dry mouth.2

Addressing Opioid-Induced Constipation

Opioid-induced constipation (OIC) is one of the most common side effects of opioid therapy. Proactive management is essential, starting with lifestyle modifications such as increasing dietary fiber intake, ensuring adequate hydration, and promoting physical activity as tolerated. Pharmacologic interventions may include the use of stool softeners, laxatives, and, for more severe cases, prescription medications like naloxegol or methylnaltrexone, which are specifically designed to treat OIC without affecting analgesic efficacy.

Mitigating Nausea and Vomiting

Nausea and vomiting can significantly impact a patient’s quality of life and willingness to continue pain medication. Anti-nausea medications such as ondansetron, metoclopramide, or prochlorperazine can be effective in managing these symptoms. Know the signs of underlying causes such as constipation or gastric distension so that these can be identified and effectively addressed. Encouraging patients to eat small, frequent meals and avoid food with strong odors can also help.

Managing Sedation and Cognitive Effects

Sedation and cognitive effects from pain medications can impair a patient’s ability to engage in daily activities and interact with others. Managing these side effects may require the prescribing physician to adjust the medication dose, change the medication regimen to less sedating alternatives, or add stimulants or wakefulness-promoting agents. If sedation or other cognitive effects are an issue, consult with a pain management specialist or the patient’s palliative care team.

Preventing and Managing Other Common Side Effects

Other common side effects of pain medications such as dry mouth, urinary retention, and itching require tailored interventions. For dry mouth, encourage frequent sips of water, use of saliva substitutes, and good oral hygiene practices. Urinary retention may necessitate a review of medications and, in some cases, catheterization. Itching can often be managed with antihistamines, although the prescriber may need to adjust the opioid dose.

A Patient-Centered Approach to Improve Quality of Life

Effective pain management in palliative care involves not only controlling pain but also minimizing the side effects of pain medications. By adopting a proactive, patient-centered approach, nurses can significantly improve the quality of life for patients receiving palliative care. It’s essential to work closely with patients and their caregivers, providing education on potential side effects and implementing strategies to manage them effectively.

For more detailed information on pain management strategies and interventions, view Cathleen Armato’s course series on pain management. This series offers comprehensive guidance on pharmacologic and nonpharmacologic pain management techniques, tailored to meet the needs of patients in palliative care settings.


  1. Anekar, A. A., Hendrix, J. M., & Cascella, M. (2023). WHO analgesic ladder. StatPearls.
  2. Wheeler, K. E., Grilli, R., Centofanti, J. E., Martin, J., Gelinas, C., Szumita, P. M., Devlin, J. W., Chanques, G., Alhazzani, W., Skrobik, Y., Kho, M. E., Nunnally, M. E., Gagarine, A. E., Ergan, B. A., Fernando, S., Price, C., Lewin, J., & Rochwerg, B. (2020). Adjuvant analgesic use in the critically ill: A systematic review and meta-analysis. Critical Care Explorations, 2(7), e0157.