Palliative care medicines: syringe drivers and anticipatory medicines

NHS inform describes a wide range of problems palliative care can help with, including pain, breathing difficulties, fatigue, eating and drinking problems, mouth problems, constipation and delirium. Treatment may mean treating the underlying condition, using medicines for the symptom or learning coping strategies. If needs are complex, the care team can ask a specialist palliative care service for help.

Most people take medicines by mouth for as long as possible. The pump and the advance medicines described below are for the moments when that becomes difficult.

Marie Curie describes a step-wise approach: simple painkillers such as paracetamol for mild pain, weak opioids for moderate pain and strong opioids such as morphine for severe pain, with other medicines such as antidepressants, anti-convulsants, steroids or bisphosphonates added for particular types of pain. It advises taking painkillers regularly as prescribed rather than waiting until pain returns.

The same page deals with three recurring worries: whether morphine speeds up death, whether opioids are only for the end of life, and whether you will become addicted. These are best raised openly with the doctor or nurse, who can explain how the dose is set, reviewed and changed.

• Pain medicines are adjusted to the person; there is no fixed dose that applies to everyone.

• Constipation and drowsiness are common opioid effects, and teams normally plan for them.

• Saying that pain is not controlled is not complaining; it prompts a review.

Marie Curie explains that the pump delivers a steady, controlled flow of medicine through a thin tube placed under the skin, so it avoids repeated injections and does not depend on swallowing. Healthcare teams suggest one when there is regular nausea or vomiting, difficulty swallowing, poor absorption of tablets, excessive drowsiness, symptoms not controlled by other routes, or as an alternative to frequent injections.

Doctors choose the medicines and doses for the person and adjust them. The nurse changes the syringe on a schedule and checks the site. If someone is worried about needles, Marie Curie notes nurses can offer numbing agents, explanation, extra time and distraction.

Marie Curie's symptom pages refer to "just in case" medicines. In practice these are small supplies of injectable medicines prescribed in advance and kept at home, in a care home or hospice, so that a nurse can give them promptly if a symptom appears suddenly, often out of hours. The usual range covers pain, sickness, agitation or restlessness, breathlessness and noisy secretions.

They are prescribed because symptoms can change quickly and getting a prescription at night can cause delay. Having them in the house does not mean they will be used soon, and not all are used. The team should explain where they are kept, who may give them and who to call. Follow the care plan for your area, as arrangements differ.

The most common question is whether a driver is a sign that death is close. Marie Curie says it is not necessarily: some people use one briefly during treatment, some for longer. It also says there is no evidence it brings death sooner.

Families also worry about sedation. Some symptom medicines cause drowsiness, and the team aims for comfort with the lowest effective doses. If someone is more sleepy than expected or seems distressed, tell the nurse; the plan can be changed.

Your district nursing team, GP, hospice or specialist palliative care service will usually have an out-of-hours number in the care plan. If someone is in severe distress and you cannot reach anyone, call NHS 111, or 999 in an emergency. Marie Curie also provides support lines and written information for families.

Caring for someone at home is demanding, and carers are entitled to ask for support. A carer's assessment through the local council is one route, and the existing guide to palliative care covers wider services.