Patients who receive hospice care are approaching the end of their lives. To be eligible for hospice, they must have been given a diagnosis by a qualified physician of six months or less to live should their illness run its expected course.
Unfortunately, many of these patients suffer from severe pain because of advanced disease.
Although hospice care has a holistic approach that addresses many aspects of a patient’s mind, body, and spirit, its major focus on improving a patient’s comfort and quality of life means that pain management is a top priority.
Assessing Pain In Hospice Patients
A complete pain assessment is typically the first step in pain management in hospice. Patients who are lucid may be asked to rank their pain on a scale from 0 to 10, with 0 representing very mild pain and 10 indicating the worst pain imaginable.
Hospice care teams are also trained in observing physical signs that a patient is in pain, which is useful for those who are unable to communicate.
Medication Used For Pain Management In Hospice
Medication is often used to manage patients’ pain while in hospice. Acetaminophen is one of the most-prescribed hospice medications, and it generally works well for relieving mild to moderate pain and reducing fevers.
Another common approach for mild to moderate pain is the use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen.
Some types of pain are associated with specific symptoms, and medications designed to alleviate those symptoms can also reduce their associated pain.
For example, steroids like dexamethasone can help with swelling and swelling-related pain, while bisacodyl can alleviate the discomfort associated with constipation.
Opioids For Pain Management In Hospice Care
Although doctors and hospice care teams do their best to ensure patients are not given medication that is stronger than necessary, many patients have high levels of pain that drugs like ibuprofen and acetaminophen cannot address. These patients often require the use of opioids.
Opioids work by attaching to the brain’s opioid receptors, which serves to block the sensation of pain in these patients.
Some of the opioids commonly given to hospice patients include morphine, oxycodone, and hydromorphone. Hydrocodone is considered a weak opioid, and it may be given alongside a nonopioid pain reliever if necessary.
If the patient’s pain gets worse, they may need stronger opioids like morphine or fentanyl.
Although these drugs can be quite effective, patients occasionally develop a tolerance to them over time and require higher doses to achieve the same effect. Hospice care teams may be able to change the dose, type or method of delivery to circumvent this challenge.
Opioids can be administered in several manners. Oral medicines, such as pills or liquids, are the most traditional method, and these options can be short-acting or provide a sustained release.
There are also adhesive patches, drug injections, medicine pumps that the patient can control, IVs, and spinal injections.
In some cases, patients may also be given adjuvant analgesics to help with their pain. Strong anti-inflammatories might help with bone or nerve pain, while muscle relaxants can help pain that is aggravated by muscle spasms or tension.
Antidepressants might be given to help patients control any existing anxiety or depression to make it easier for them to control their pain, and these drugs can also help address pain caused by nerve damage.
Addressing Concerns About Opioids In Hospice Care
The prospect of a loved one taking opioids can be very concerning given all the headlines about the dangers of opioid addiction.
Although these concerns are indeed valid among the general population, it is important to keep in mind that hospice patients are not expected to live long enough to develop any sort of addiction.
The priority at this point in a person’s life is allowing them to live their final days with as much comfort and peace as possible, and effective pain relief plays a significant role in enhancing their quality of life.
Monitoring Patients’ Pain
The team pays close attention to the patient’s verbal and nonverbal communication about their pain levels, and they regularly discuss how well their pain management approaches are working and whether or not adjustments are needed to ensure maximum comfort.
In addition, hospice teams take steps to ensure that the opioids a patient is given are stored securely and not being misused by others in the patient’s home.
Other Approaches To Pain Management In Hospice Care
Hospice embraces a holistic approach toward pain, which means they also address pain from an emotional and spiritual point of view. This might include distraction techniques such as music therapy and visits from social workers and chaplains.
Learn More About Pain Management During Hospice Care
Although the final stages of a terminal illness can be painful, patients do not have to suffer. Get in touch with the professional care team at Harbor Light Hospice to find out more about how hospice care can help with pain management and give your loved one the best quality of life possible.