Beyond Opioid Dose Conversions: Advanced Topics in Palliative Care Pharmacology for the Consultation-Liaison Psychiatrist

Abstract: With the growth of hospice and palliative medicine as a discrete specialty with its own robust research paradigm, the science of pain and physical symptom management in individuals with serious illness is rapidly evolving. Many of the most efficacious and commonly utilized interventions for physical symptoms in the setting of serious medical illness are pharmacologic. CL psychiatrists, even if not directly driving these interventions, are routinely called upon to treat serious ill patients with complex symptom management needs, to manage psychiatric comorbidities in parallel to pain and symptom management, and to manage iatrogenic sequelae of interventions for pain and symptom management.

This interactive workshop will review high-yield information about pharmacologic pain and symptom management geared toward the CL psychiatrist. Our focus will not be on training in symptom management per se, but rather on the knowledge necessary to provide optimal, collaborative psychiatric care for patients receiving pharmacologic treatment for pain and other symptoms in the setting of serious medical illness. What are the core principles driving symptom management approaches? How are psychiatric agents used in pain and symptom management? What are common psychiatric complications and drug interactions of frequently utilized pain and symptom management regimens?

Using a team-based learning approach driven by clinical challenges, we will discuss pain, nausea/vomiting, anorexia, dyspnea. Participants should come prepared to work together in breakout groups to manage clinical scenarios with the guidance of a panel of consultation-liaison psychiatrists and hospice and palliative medicine physicians with extensive experience in palliative care psychiatry.

Dr. Daniel Shalev is a hospice and palliative medicine physician and consultation-liaison psychiatrist at Weill Cornell. He will present on psychiatry-relevant differences among opioids for serious illness pain management with a focus on neurotoxicity and drug interactions.

Dr. Leah Rosenberg is a hospice and palliative medicine physician at Massachusetts General Hospital with expertise in inpatient palliative care and psychological aspects of palliative care. She will present on the pharmacology of anti-emetics as they pertain to the CL psychiatrist.

Dr. Paul Noufi is a hospice and palliative medicine physician and a consultation-liaison psychiatrist at MedStar. He will present on challenges around appetite stimulation in serious illness with a focus on the benefits and pitfalls of employing psychopharmacologic agents to improve appetite in serious illness.

Dr. Olivia Hurwitz is a consultation-liaison psychiatry fellow at Thomas Jefferson University and a future hospice and palliative medicine fellow. She will present on the use of benzodiazepines and opioids in dyspnea management, with a focus on risk stratification.