As patients with a terminal illness approach the end of their lives, they may experience pain. The emphasis at this stage of disease is on maximizing comfort, and there are a broad range of pain management aids available to ensure patients do not have to suffer.
Hospice care, a type of care that is offered to patients with a terminal illness who have been diagnosed with six months or less to live if their illness runs its typical course, has a strong focus on pain relief and uses a holistic approach to ensuring patients do not spend their final days in suffering.
A report in the American Journal of Hospice and Palliative Care revealed that more than half of patients who have terminal cancer suffer from poorly managed pain, which is not only distracting but also largely unnecessary.
There are many good options available for alleviating pain in these patients, with experts estimating that as many as 95 percent of dying patients should be able to enjoy substantial relief from their pain(1).
Causes of End-of-life Pain
Although pain is fairly common among people living with a terminal illness, it is important to note that some patients do not experience any pain. Everyone’s experience is different, and pain may come and go in the final months of a person’s life.
This pain may be caused by the terminal illness itself or another painful illness the patient may also be suffering from, such as arthritis. It could also be the result of treatments for their condition, such as operations, or the side effects of treatments. For example, constipation due to cancer medication can be very painful for patients.
Assessing Pain In Terminally Ill Patients
For patients who are able to communicate their pain, it is important to acknowledge what they are feeling and not dismiss it. Although no one can promise to eliminate their pain entirely, it is helpful to reassure them that every effort will be made to help them manage their pain.
It is also important to understand that pain is not always physical. It may also be psychological, such as emotional or spiritual pain associated with the prospect of dying. Some patients may experience both types of pain.
Psychological pain can increase physical pain in an unpleasant condition known as “total pain”. For example, patients who feel anxious, isolated or distressed may experience more acute physical pain as well. Addressing these underlying psychological issues can sometimes help alleviate physical pain.
Regular pain assessments can help find the best methods of managing pain. There are a few questions that can be used to get a clearer picture of how the patient is feeling, such as:
- Where is the pain?
- How bad is the pain on a scale of 1 to 10?
- When did it start, and how long does it last?
- Is it a new or recurring pain?
- What does the pain feel like? For example, is it a sharp pain or an ache?
- How is it impacting your daily activities?
- What makes it feel better or worse?
In non-communicative patients, there are other methods that can be used to understand their degree of suffering. Those who cannot communicate verbally but are conscious may use picture cards or visual charts.
Patients who cannot communicate at all are observed by their hospice team or physicians for signs of pain, such as refusing care or food, crying or frowning, groaning or grimacing, mood changes, breathing changes, withdrawal, reluctance to move, guarding the painful area, or favoring one side when moving or walking.
Pain Management Options
Managing pain at the end of life is important so that patients who are near death can spend their time connecting with their loved ones and reflecting upon their lives. Moreover, pain treatments can facilitate breathing and help patients to relax and sleep, giving them a better quality of life during the time they have left.
One of the most common and effective approaches to treating end-of-life pain is medications known as analgesics, or painkillers. Although some patients and families have reservations about painkillers, such as side effects and the possibility of developing an addiction, many of these concerns do not apply to patients who are not expected to live longer than a few months.
Simple painkillers like ibuprofen and acetaminophen may be given for mild pain, while moderate pain might call for weak opioids like tramadol or codeine.
More severe pain can be addressed with strong opioids like oxycodone or morphine. It may take some trial and error to find the right medication and dosage to provide relief.
Alternative Pain Relief
Some non-pharmacological techniques for addressing pain that may be used by hospice care teams include heat and cold on painful areas, occupational therapy, acupuncture, TENS, music therapy, massage and talk therapy.
Reach Out To The Hospice Care Team For More Info On Pain Management In Hospice
Patients and their families need to understand their options when it comes to pain management so they can enjoy the best quality of life possible as their life draws to a close. If you or a loved one is experiencing pain as part of a terminal illness, reach out to the compassionate team at Harbor Light Hospice.