Hospice Care Focus: Pain Control at the End of Life

At the end of life, a patient and loved ones have many issues to deal with. Suffering needlessly from pain should not be one of those issues.

Hospice care staff know that effective pain control at the end of life is a fundamental right of the patient and family ______________________

Hospice care refers to end-of-life care in which the goal is comfort, symptom management, and quality of life, as opposed to finding a cure. It is coordinated and provided by an interdisciplinary care team—one that includes the patient's physician, plus professionals in nursing, social work, pastoral care, and so on. Hospice care serves not only the patient, but the patient's family as well.

Hospice staff and others who care for terminally ill patients know the importance of pain management. The patient has a fundamental right to pain relief, including ample medication, and as much control as possible over the dosage. Medications can be adjusted for maximum comfort, but to avoid excess drowsiness. The hospice team will work with the patient and family members to provide the best possible symptom control.

It is important to listen to patients when they say they are experiencing pain. For patients, pain may be both a physical and an emotional experience. Only the patient can best describe the pain and its intensity. The patient's healthcare team needs a clear understanding of the patient's pain level, the type of pain he or she is experiencing, and how well medications are or are not controlling it. The nurse or physician will often ask the patient to rate the pain he or she is experiencing on a scale of 1 through 10, and to describe the type of pain, using words such as "sharp," "aching," "stabbing," "dull," "burning," and so forth.

This is because the type of pain is as important as its intensity in determining the best medications for the patient. A combination of medications often yields the most comfort—including not only medications exclusively for the treatment of pain, but also additional medications that help relieve depression, muscle tension, anxiety, or inflammation.

Frequent Concerns about Pain Medication

Hospice patients and family may have questions about pain medications. Here are some common concerns:

"The pain medication makes me too sleepy." Some pain medications can make the patient feel drowsy. It is important to know that when first taking a pain medication, a patient who has been losing sleep due to discomfort may sleep more the first few days after beginning the drug, because he or she is finally able to relax. The medication can then be adjusted to decrease sleepiness but maintain comfort.

"The pain medication makes me constipated." Constipation is a common side effect of many pain medications. Other factors may also be contributing to constipation, such as decreased activity, decreased appetite, or a disease process. Constipation may be treated with a change of diet or medication.

"If I take pain medication now, what will I do if the pain gets really bad?" Pain does not always worsen. If it does, medication dosages may be increased, or the medication can be changed, to keep pain managed effectively.

"Will I become addicted?" Taking medications to treat pain is entirely different from abusing drugs. In a hospice situation, the goal is an important one: alleviating pain and maximizing quality of life. If "addiction" is a concern for the patient, it is important to realize that this use of narcotic and other drugs is very different from "getting high." For some patients and family members, there may be a stigma attached to the use of certain medications; the hospice team can help allay these concerns.

Taking prescribed pain medication regularly as directed can help manage pain effectively and minimize the need for additional medication.

Pain and discomfort can also be managed by other methods. For example, meditation, music, or guided imagery can reduce pain by helping a person to relax. Using cool or warm packs, or changing position may also help in soothing aches. Massage may help to decrease discomfort by increasing circulation and relaxing muscles. Hospice workers are trained to assist patients and families with techniques that can help the patient reach the end of life with the greatest possible comfort and dignity.