• drug administration
• hospital care
• pain
• pharmacology
• terminal care

Palliative care puts the patients at the centre of all that is done and seeks to focus on ensuring patient calmness, comfort and dignity. The management of pain within the palliative care population can be a complex process and needs to be individualised. Good, timely pain control while avoiding overburdening side effects plays a vital role.

Palliative care physicians always want to have the most tools for managing patients’ symptoms. This will involve alternative routes of administration but also using, or repurposing of medications, or indeed, the rediscovering of medications that have fallen from collective memory.

This letter concerns a medication that falls into both categories as one that has largely fallen out of use and could be used via a different route.

Nefopam is a medication that was originally formulated in the 1960s as an antidepressant. It is a non-opioid, non-steroidal and centrally acting analgesic drug. Its mechanism of action is not fully understood, however may include the following1:

1. Reuptake inhibition of monoamine, serotonin, dopamine and norepinephrine, therefore, altering descending pain modulation (similar to many antidepressants used in pain control).

2. Inhibition of calcium …