Effectiveness of topicals for pain and anxiety management

I have seen firsthand the benefits and drawbacks of different medications for managing pain and anxiety in terminally ill patients. Fentanyl patches and Ativan gel are two commonly used medications, but their effectiveness can vary depending on a patient’s build and weight, particularly for very thin or cachexic individuals.

Fentanyl Patches

Fentanyl is a potent opioid medication used for pain management in hospice and palliative care. It is often prescribed in patch form, which is applied to the skin and releases the medication over a period of 72 hours.

Now, let’s talk about why fentanyl patches might not be effective for thin and cachexic patients. When we talk about thin and cachexic patients, we’re referring to patients who have lost a significant amount of weight and muscle mass, often due to advanced illness.

One of the main reasons that fentanyl patches might not be effective for these patients is that they rely on a certain amount of fat to be absorbed properly. Specifically, fentanyl is absorbed through the skin and into the bloodstream, and fat cells in the skin help to store the medication and release it slowly over time. Thin and cachexic patients have less fat, which means that the medication may not be absorbed as well or as consistently.

It is also crucial to educate patients and their families on the proper use and disposal of fentanyl patches. Accidental exposure or misuse can lead to respiratory depression, coma, and even death.

Ativan Gel

Ativan (lorazepam) is a benzodiazepine medication commonly used for anxiety and agitation in hospice and palliative care. Ativan gel is a topical form of the medication that can be applied to the wrists or soles of the feet for faster onset of action.

However, for very thin or cachexic patients, Ativan gel can also be less effective due to decreased subcutaneous tissue and blood flow. This can result in slower absorption and reduced anxiety relief. It is important to monitor the patient’s response to the medication closely and adjust the dosage as needed.

It is also important to note that benzodiazepines can cause respiratory depression and should be used with caution in patients with compromised lung function.

Overall Considerations

When managing pain and anxiety in very thin or cachexic patients, it is important to consider the following:

• Monitor the patient’s weight and build when prescribing medications
• Educate patients and their families on the proper use and disposal of medications, particularly opioids like fentanyl
• Monitor the patient’s response to medications closely and adjust the dosage as needed
• Use caution when prescribing medications that can cause respiratory depression in patients with compromised lung function

As always, communication between the healthcare team, patient, and family is crucial for effective pain and symptom management in hospice and palliative care.

Resources

Managing Pain in the Dying Patient: https://www.aafp.org/pubs/afp/issues/2000/0201/p755.html

WebMD — Topical Pain Relievers: https://www.webmd.com/pain-management/topical-pain-relievers

Cleveland Clinic — Topical Pain Relief: How It Works: https://health.clevelandclinic.org/topical-pain-relief-what-is-it-and-how-does-it-work/

Medical News Today — Pain Management Techniques: https://www.medicalnewstoday.com/articles/pain-management-techniques

National Prescribing Service (NPS) — Pain Management Hub: https://www.nps.org.au/pain-management-hub