Palliative Care and Pain Management in the United States



Palliative Care Pain Management Palliative Care Service Palliative Care Specialist Hospice Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to acknowledge David Clark and Russell Portenoy for kindly reviewing the manuscript for this chapter and for their contributions to the field, without which this work would not have been possible.


  1. 1.
    Clark D. Cicely Saunders – founder of the hospice movement selected letters 1959–1999. Oxford: Oxford University Press; 2005.Google Scholar
  2. 2.
    Lewis M. Medicine and the Care of the Dying. Oxford: Oxford University Press; 2007.Google Scholar
  3. 3.
    Stoddard S. The Hospice Movement. NY: Vintage; 1992.Google Scholar
  4. 4.
    Saunders C. The modern hospice. In: Wald F, ed. Quest of the Spiritual Component of Care for the Terminally Ill: Proceedings of a Colloquium. New Haven: Yale Unveristy School of Nursing; 1986:41–48.Google Scholar
  5. 5.
    Mount B. The Royal Victoria Hospital Palliative Care Service: a Canadian experience. In: Saunders C, Kastenbaum R, eds. Hospice Care on the International Scene. New York: Saunders; 1997:73–85.Google Scholar
  6. 6.
    Clinical Practice Guidelines for Quality Palliative Care. National Concensus Project for Quality Palliative Care. 2003;, last accessed 4/23/07.
  7. 7.
    Brennan F. Palliative care as an international human right. J Pain Symptom Manage. 2007;33(5):494–499.CrossRefPubMedGoogle Scholar
  8. 8.
    Clark D, Seymour J. Reflections on Palliative Care. Philadelphia: Open University Press; 1999.Google Scholar
  9. 9.
    Morrison RS, Maroney-Galin C, Kralovec PD, Meier DE. The growth of palliative care programs in United States hospitals. J Palliat Med. Dec 2005;8(6):1127–1134.CrossRefPubMedGoogle Scholar
  10. 10.
    von Gunten CF. Secondary and tertiary palliative care in US hospitals. JAMA. Feb 20 2002;287(7):875–881.CrossRefGoogle Scholar
  11. 11.
    American Academy of Hospice and Palliative Medicine Website. accessed 4/23/07).
  12. 12.
    Du Boulay S. Ciceley Saunders. 2 ed. London: Hodder & Stoughton; 1994.Google Scholar
  13. 13.
    Saunders C. St. Christopher’s Hospice. Br Hosp J Soc Serv Rev. 1967;77(10):2127–2130.Google Scholar
  14. 14.
    Clark D. ‘Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Soc Sci Med. 1999;49(6):727–736.CrossRefPubMedGoogle Scholar
  15. 15.
    Saunders C, Baines M. Living with Dying – The management of terminal disease. Oxford: Oxford University Press; 1983.Google Scholar
  16. 16.
    Saunders C. The evolution of palliative care. Patient Education and Counseling. 2000;41:7–13, cited in Saunders, C. Selected Writings 1958–2004.CrossRefPubMedGoogle Scholar
  17. 17.
    Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330(9):592–596.CrossRefPubMedGoogle Scholar
  18. 18.
    Gallagher R. Treatment planning in pain management – integrating medical, phyhsical, and behavioral therapies. Med Clin North America. 1999;83(3):823–847.CrossRefGoogle Scholar
  19. 19.
    Warfield C, Bajwa Z, eds. Principles and Practice of Pain Medicine. 2nd ed. NY: Mcgraw-Hill; 2004.Google Scholar
  20. 20.
    Engel g. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–136.CrossRefPubMedGoogle Scholar
  21. 21.
    Borrell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576–582.CrossRefPubMedGoogle Scholar
  22. 22.
    Twycross R. Introducing Palliative Care. NY: Radcliffe Medical Press; 1995.Google Scholar
  23. 23.
    Arber A. Is pain what the patient says it is? Interpreting an account of pain. Int J Palliat Nurs. 2004;10(10):491–496.PubMedGoogle Scholar
  24. 24.
    Bonica JJ. Evolution and current status of pain programs. J Pain Symptom Manage. 1990;5(6):368–374.CrossRefPubMedGoogle Scholar
  25. 25.
    Saunders C. Dying of Cancer. St. Thomas’s Hospital Gazette. 1958;56(2):37–47, cited in Clark 2006, Cicely Saunders -selected writings 1958–2004,pp2001–2011.Google Scholar
  26. 26.
    Bonica JJ. Cancer pain: a major national health problem. Cancer Nurs. 1978;1(4):313–316.CrossRefPubMedGoogle Scholar
  27. 27.
    Medicare Benefit Policy Manual. Last accessed 4/17/07.
  28. 28.
    Joranson DE. Are health-care reimbursement policies a barrier to acute and cancer pain management? J Pain Symptom Manage. 1994;9(4):244–253.CrossRefPubMedGoogle Scholar
  29. 29.
    Ferrell BR, Griffith H. Cost issues related to pain management: report from the Cancer Pain Panel of the Agency for Health Care Policy and Research. J Pain Symptom Manage. 1994;9(4):221–234.Google Scholar
  30. 30.
    Saunders C. Evaluation of hospice activities. J. Chronic Disease. 1984;37(11):871, cited by Clark, 2006.CrossRefGoogle Scholar
  31. 31.
    Standards for Hospice 2004–5: Joint Commission; 2005.Google Scholar
  32. 32.
    Billings JA. A primer on training slots for graduate medical education. J Palliat Med. 2007;10(1):12–16.CrossRefPubMedGoogle Scholar
  33. 33.
    National Hospice and Palliative Care Organization.Available at:–2005.pdf (Last accessed 6/27/07).
  34. 34.
    Field MJ, Cassel CK, Institute of Medicine (U.S.). Committee on Care at the End of Life. Approaching death: improving care at the end of life. Washington, D.C.: National Academy Press; 1997.Google Scholar
  35. 35.
    Greiner KA, Perera S, Ahluwalia JS. Hospice usage by minorities in the last year of life: results from the National Mortality Followback Survey. J Am Geriatr Soc. 2003;51(7):970–978.CrossRefPubMedGoogle Scholar
  36. 36.
    Kapo J, MacMoran H, Casarett D. "Lost to follow-up": ethnic disparities in continuity of hospice care at the end of life. J Palliat Med. 2005;8(3):603–608.CrossRefPubMedGoogle Scholar
  37. 37.
    Doyle D, Hanks GWC, MacDonald N. Oxford Textbook of Palliative Medicine. Oxford; New York: Oxford University Press; 1993.Google Scholar
  38. 38.
    Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997;278(9):733–738.Google Scholar
  39. 39.
    Greco PJ, Schulman KA, Lavizzo-Mourey R, Hansen-Flaschen J. The Patient Self-Determination Act and the future of advance directives. Ann Intern Med. Oct 15 1991;115(8):639–643.PubMedGoogle Scholar
  40. 40.
    SUPPORT. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA. 1995;274(20):1591–1598.CrossRefGoogle Scholar
  41. 41.
    Lynn J, Arkes HR, Stevens M, et al. Rethinking fundamental assumptions: SUPPORT’s implications for future reform. Study to Understand Prognoses and Preferences and Risks of Treatment. J Am Geriatr Soc. 2000;48(5 Suppl):S214–221.PubMedGoogle Scholar
  42. 42.
    Teno J, Lynn J, Wenger N, et al. Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. Apr 1997;45(4):500–507.PubMedGoogle Scholar
  43. 43.
    Pritchard RS, Fisher ES, Teno JM, et al. Influence of patient preferences and local health system characteristics on the place of death. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Risks and Outcomes of Treatment. J Am Geriatr Soc. 1998;46(10):1242–1250.PubMedGoogle Scholar
  44. 44.
    Portenoy RK, Lupu DE, Arnold RM, Cordes A, Storey P. Formal ABMS and ACGME recognition of hospice and palliative medicine expected in 2006. J Palliat Med. Feb 2006;9(1):21–23.CrossRefPubMedGoogle Scholar
  45. 45.
    JCAHO. Pain Standards. at 2001.
  46. 46.
    Bonica JJ, Backup PH. Control of cancer pain. Northwest Med. 1955;54(1):22–28.PubMedGoogle Scholar
  47. 47.
    Berger A, Shuster J, von Roenn J, eds. Principles and Practice of Palliative Care and Supportive Oncology. 3rd ed. Philidelphia: Lippincott Williams & Wilkins; 2007.Google Scholar
  48. 48.
    Doyle D, Hanks GW, Cherny N, Calman K, eds. Oxford Textbook of Palliative Medicine. 3rd ed. Oxford: Oxford University Press; 2005.Google Scholar
  49. 49.
    Cark D. The rise and demise of the Brompton Cocktail. In: Meldrum M, ed. Opioids and Pain Relief: A Historical Perspective. Progress in Pain Research and Management. Vol 25. Seattle: IASP press; 2003:85–98.Google Scholar
  50. 50.
    Twycross RG, Gilhooley RA. Letter: Euphoriant elixirs. Br Med J. 1973;4(5891):552.CrossRefPubMedGoogle Scholar
  51. 51.
    Kaiko RF, Kanner R, Foley KM, et al. Cocaine and morphine interaction in acute and chronic cancer pain. Pain. 1987;31(1):35–45.CrossRefPubMedGoogle Scholar
  52. 52.
    Twycross RG. Introducing palliative care. 2nd ed. Oxford; New York: Radcliffe Medical Press; 1997Google Scholar
  53. 53.
    Dalal S, Palat G, Bruera E. Chronic nausea and vomiting. In: Berger A, Shuster J, von Roenn J, eds. Principles and Practice of Palliative Care and Supportive Oncology. 3rd ed. Philadelphia: Lippincott Williams &Wilkins; 2007:151–162.Google Scholar
  54. 54.
    Herndon CM, Jackson KC, 2nd, Hallin PA. Management of opioid-induced gastrointestinal effects in patients receiving palliative care. Pharmacotherapy. 2002;22(2):240–250.CrossRefPubMedGoogle Scholar
  55. 55.
    Zwakhalen SM, Hamers JP, Abu-Saad HH, Berger MP. Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr. 2006;6:3.CrossRefPubMedGoogle Scholar
  56. 56.
    Portenoy RK, Sibirceva U, Smout R, et al. Opioid use and survival at the end of life: a survey of a hospice population. J Pain Symptom Manage. 2006;32(6):532–540.CrossRefPubMedGoogle Scholar
  57. 57.
    Hallenbeck J. Evidence-based medicine and palliative care. J Palliat Med. 2008;11(1):2–4.Google Scholar
  58. 58.
    Higginson IJ. Evidence based palliative care. There is some evidence-and there needs to be more. Bmj. 1999;319(7208):462–463.PubMedGoogle Scholar
  59. 59.
    Aoun SM, Kristjanson LJ. Evidence in palliative care research: How should it be gathered? Med J Aust. 2005;183(5):264–266.PubMedGoogle Scholar
  60. 60.
    Aoun SM, Kristjanson LJ. Challenging the framework for evidence in palliative care research. Palliat Med. 2005;19(6):461–465.CrossRefPubMedGoogle Scholar
  61. 61.
    Devery K. The framework for evidence in palliative care: narrative-based evidence. Palliat Med. 2006;20(1):51.CrossRefPubMedGoogle Scholar
  62. 62.
    Sackett DL, Strause S, Richardson WS, Rosenberg WM, Haynes RB. Evidence-based medicine. 2nd ed. Edinburgh: Chruchill Livingstone; 2000.Google Scholar
  63. 63.
    Clinical Evidence Handbook. London: BMJ Publishing Group; 2007.Google Scholar
  64. 64.
    Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. Jama. 1998;279(23):1877–1882.CrossRefPubMedGoogle Scholar
  65. 65.
    Wolfe J, Grier HE, Klar N, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med. 2000;342(5):326–333.CrossRefPubMedGoogle Scholar
  66. 66.
    Bonica J, ed. International Symposium on Pain. NY: Raven Press; 1974. Advances in Neurology; No. 4.Google Scholar
  67. 67.
    Weissman DE, Block SD. ACGME requirements for end-of-life training in selected residency and fellowship programs: a status report. Acad Med. 2002;77(4):299–304.Google Scholar
  68. 68.
    VanGeest JB. Process evaluation of an educational intervention to improve end-of-life care: the Education for Physicians on End-of-Life Care (EPEC) program. Am J Hosp Palliat Care. Jul-Aug 2001;18(4):233–238.CrossRefPubMedGoogle Scholar
  69. 69.
    Stratos GA, Katz S, Bergen MR, Hallenbeck J. Faculty development in end-of-life care: evaluation of a national train-the-trainer program. Acad Med. Nov 2006;81(11):1000–1007.CrossRefGoogle Scholar
  70. 70.
    Sullivan AM, Lakoma MD, Billings JA, Peters AS, Block SD. Creating enduring change: demonstrating the long-term impact of a faculty development program in palliative care. J Gen Intern Med. Sep 2006;21(9):907–914.CrossRefPubMedGoogle Scholar
  71. 71.
    von Gunten CF. Fellowship training in palliative medicine. J Palliat Med. Apr 2006;9(2):234–235.CrossRefGoogle Scholar
  72. 72.
    Miller M, Wee B. Medical Education. In: Wee B, Hughes N, eds. Education in Palliative Care. Oxford: Oxford University Press; 2006:14–22.Google Scholar
  73. 73.
    Wee B, Hughes N. Education in Palliative Care – Building a culture of learning. Oxford: Oxford University Press; 2007.Google Scholar
  74. 74.
    Hallenbeck J. Palliative care training for the generalist a luxury or a necessity? J Gen Intern Med. 2006;21(9):1005–1006.CrossRefPubMedGoogle Scholar
  75. 75.
    Morrison RS, Wallenstein S, Natale DK, Senzel RS, Huang LL. “We don’t carry that” – failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000;342(14):1023–1026.CrossRefPubMedGoogle Scholar
  76. 76.
    Byock I, Twohig JS, Merriman M, Collins K. Promoting excellence in end-of-life care: a report on innovative models of palliative care. J Palliat Med. Feb 2006;9(1):137–151.Google Scholar
  77. 77.
    Lynn J, Chaudry E, Noyes Simon L, Wilkinson A. The Common Sense Guide to Improving Palliative Care. NY: Oxford University Press; 2007.Google Scholar
  78. 78.
    Seymour J, Clark D, Winslow M. Pain and palliative care: the emergence of new specialties. J Pain Symptom Manage. Jan 2005;29(1):2–13.CrossRefPubMedGoogle Scholar
  79. 79.
    Meldrum M. The ladder and the clock: cancer pain and public policy at the end of the twentieth century. J Pain Symptom Manage. 2005;29(1):41–54.CrossRefPubMedGoogle Scholar
  80. 80.
    Schofferman J. Long-term use of opioid analgesics for the treatment of chronic pain of nonmalignant origin. J Pain Symptom Manage. 1993;8(5):279–288.CrossRefPubMedGoogle Scholar
  81. 81.
    Houde R. The use and misuse or narcotics in the treatment of chronic pain. In: Bonica J, ed. International Symposium on Pain. New York: Raven Press; 1974:527–536.Google Scholar
  82. 82.
    Fishbain DA, Rosomoff HL, Rosomoff RS. Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain. 1992;8(2):77–85.PubMedCrossRefGoogle Scholar
  83. 83.
    Portenoy RK. Chronic opioid therapy in nonmalignant pain. J Pain Symptom Manage. 1990;5(1 Suppl):S46–62.PubMedGoogle Scholar
  84. 84.
    Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171–186.Google Scholar
  85. 85.
    Charlton J, ed. Core curriculum for professional education in pain. Seattle: IASP Press; 2005.Google Scholar
  86. 86.
    Manchikanti L, Boswell MV, Raj PP, Racz GB. Evolution of interventional pain management. Pain Physician. 2003;6(4):485–494.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Stanford University School of Medicine, VA Palo Alto Health Care SystemStanfordUSA

Personalised recommendations