Palliative Care Methods for Controlling Pain
palliative care is used to manage a disease or medical condition that is serious or life threatening by easing pain and other associated physical, emotional, or psychosocial symptoms
Palliative care also eases other distressing symptoms, like depression, anxiety, fatigue, insomnia, and shortness of breath. Palliative care provides advanced care planning and a support system to help you live a life that is as active, fulfilling, and as pain-free as possible.
Principles of palliative care and pain medicine
The first step in managing pain is to do a total pain assessment. You may be asked to choose a number from 0 to 10 to rank your pain, with 0 being very mild pain and 10 being the worst possible pain you could have.
Understanding opioid drugs
Opioid drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opioid drugs is available, and they can be taken in a variety of ways. One drawback of these medicines is that, over time, you will almost certainly develop a tolerance to the one you’re taking and need higher doses to get the same effect. One way your healthcare provider may get around this problem is by switching the type, dose, or the way the drug is given.
Understanding helper drugs
These medicines, called adjuvant analgesics, can help control pain in certain situations.
How to properly manage patients’ pain
One recent evening in Denver, a man known to EMS to have a history of drug abuse was brought by ambulance to Denver General Hospital after being hit by a car. A bone in his arm was poking through his skin, but paramedics didn’t give him pain medication. “We’re familiar with him. He likes his drugs,” Christopher Colwell, M.D., an emergency physician and medical director for the Denver Fire Department and Denver Health Paramedic Division, recalls medics telling him
Colwell was appalled. The man was obviously in severe pain, yet he was being denied relief because of his drug dependency status. “It was astounding. Here was someone with a bone sticking out of his arm, whose pain should have been treated,” he says. “Yet medics were not able to step out of that and treat the patient based on his current situation rather than his history.”
Relieving pain becomes a priority
For a condition as uncomfortable and as universal as pain, it took until the mid-’90s for pain management to become a priority in hospitals. “At the time, we were really coming to full recognition of how poorly we were doing in managing patients’ pain,” says Bob Twillman, Ph.D., director of policy and advocacy for the American Academy of Pain Management in Sonora, Calif.
Research papers showed that patients with poorly treated pain were more likely to end up with chronic pain conditions, post-traumatic stress, depression, and other physical and psychological problems, while other research showed that proper pain management could help with wound healing and get people home from the hospital sooner, Twillman says. At the same time, new pharmaceuticals came on the market, providing alternative pain-relief options. “Prior to the mid-’90s, we had oxycodone (Percocet) and hydrocodone (Vicodin, Lortab) and only one long-acting opioid—morphine,” Twillman says. “But then fentanyl patches and Oxycontin became available. We had a lot more options for treating people not just with acute pain, but with longstanding pain related to cancer or other pain conditions.”
Responders reluctant to give drugs
Even as hospitals worked to better manage pain, awareness of the importance of pain management in the prehospital setting lagged. EMS has no pain-management standards as part of accreditation. (The Commission on Accreditation of Ambulance Services, or CAAS, doesn’t include a pain-management standard as part of its clinical assessment.) Nor is pain management a major part of EMS education, Taigman says. Sure, pain medications are touched on. But there are no long discussions about the role of the prehospital care provider in treating pain. “There’s a long module on reading EKGs, a super long module on trauma assessment and management, but there’s no module on pain management,” he says.
How to Choose the Best Over-the-Counter Pain Medicine
Pain is one of the most challenging symptoms to treat. It can be caused by many different things such as heat, cold, pressure, traction, inflammation, and nerve damage. Over-the-counter (OTC) pain medicines offer a wide variety of treatment options for the various types of pain. It’s important to understand the cause of your pain in order to choose the best medicine(s) to treat it. I’ll review some of the most common types of pain, and explain which active ingredients are best suited to provide relief.
Headaches & Migraines
Believe it or not, doctors are still not completely sure what causes headaches. The Mayo Clinic notes, “Chemical activity in your brain, the nerves or blood vessels of your head outside your skull, or muscles of your head and neck — or some combination of these factors — may play a role in primary headaches.”
The most common kind of headache is known as a “tension headache” and as the name suggests, it often feels like a tight band around your head. Asprin, ibuprofen, naproxen, and acetaminophen all are effective to treat tension headaches, but it’s important not to overuse OTC headache medicines or else you may experience headaches from the medicines themselves. According to physician resource Up to Date, “over-use headaches” can occur if you use these medicines for more than nine days over the course of a month.
Arthritis literally means “joint inflammation” and it is one of the most common causes of pain experienced by adults. Most arthritis is due to normal “wear-and-tear” on joints and is known as osteoarthritis. There are less common types of arthritis that are caused by an autoimmune reaction to joint tissues (such as rheumatoid and psoriatic arthritis).
Muscle pain is usually caused by micro-tears in muscle fibers that stimulate nerve endings in the surrounding tissues. Nerve endings that sense inflammation, stretch and pressure exist near muscle tissue and their messages are usually perceived by the brain as dull, aching pain sensations. People experience muscle pain most commonly after exertion or exercise. In addition to oral anti-inflammatory medicines, acetaminophen, and NSAIDs, many OTC muscle pain treatments involve the application of heat, or superficial cooling and anti-inflammatory creams. The active ingredients in topical consumer products that have been found to be helpful in easing muscle pain and soreness are: menthol, camphor, methyl salicylate, capsaicin, heat wraps, and cold packs.
Pain Management During End-of-life
Understanding Pain During End-of-life
Unfortunately, what should be a time to spend with loved ones is all too often accompanied by severe pain. To give just one example, a report published in the American Journal of Hospice and Palliative Care revealed that for over 50% of patients with terminal cancer, their pain is managed insufficiently. Especially at the end of life, serious pain is an unnecessary distraction which can rob terminal patients of precious time with the people who they value the most
Understanding Pain Management
Pain management and palliative care has advanced greatly over the past few decades and this no longer needs to be the case. June Dahl, PhD, a professor of pharmacology at the University of Wisconsin-Madison and a founder of the American Alliance of Cancer Pain Initiatives says that over 90% and perhaps as many as 95% of terminal patients should be able to be given a significant amount of relief from their pain. While Dahl says that eliminating pain completely isn’t realistic, it is realistic for patients to expect that their pain can be minimized to the point that it could be described as 2 or 3 on a scale of 0 to 10.
Pain relief should always be one of the top priorities in the treatment of terminal patients. Too much emphasis on treating other symptoms or the underlying disease in the face of a poor prognosis can mean that terminal patients will have to wait needlessly to receive hospice care and to benefit from a more aggressive pain management strategy
Where Support Is Provided
Terminally ill patients may receive hospice care in a dedicated hospice facility or, as is increasingly the case, in their own home, where patients may feel more at ease. Hospice care is provided by a team which includes doctors, nurses, physician assistants, therapists and chaplains make regular visits to the patient in their home and give instruction to family members and other caregivers on administering pain medications and comforting the patient. These hospice care specialists have also been trained on assisting patients and their loved ones to handle the emotional and mental toll of dealing with a terminal illness and end of life
Complications of Pain Management
Even with regular administration of pain medication, terminal patients may still need higher dosages at times or a change in their medication routine in order to manage their pain. Caregivers need to monitor the pain of their loved ones by asking the patient regularly about their pain and react appropriately. Pain can quickly become acute at the end of life and patients may not always volunteer this information, so it becomes especially important for caregivers to ask this important question regularly.
All You Need to Know About Pain Management in Hospice
When faced with a serious illness, patients are accustomed to seeking out the support of a specialist. Facing heart disease, patients want a well-trained cardiologist by their side. When diagnosing a particular type of cancer, a primary care physician will refer their patient to an oncologist with expertise in that area. For terminally ill patients, Crossroads Hospice & Palliative Care is the comfort care specialist patients need to control pain and other end-of-life symptoms.
Hospice Pain Management
Pain management is one of the primary goals of hospice care – keeping the patient comfortable and managing symptoms to ensure they have the highest quality of life for as long as they live.
Signs and Symptoms of Pain
While many patients can assess and communicate their pain levels, other patients can sometimes believe that admitting pain makes them appear weak – which is not true. In other cases, Alzheimer’s disease and other dementia make it difficult for individuals to communicate their needs. In any case, caregivers should keep an eye out for signs and symptoms that indicate their loved one is in pain.
Hospice Pain Medication Protocol
Medication is an essential tool in hospice pain management. This includes the use of opioids to control pain. Opioids work by attaching themselves to “opioid receptors” in the brain, blocking the feeling of pain. They are used to treat moderate to severe pain
Managing Emotional and Spiritual Pain
In addition to managing physical pain, the hospice pain management plan will assess the patient’s emotional and spiritual pain.