Many people experience pain in the final chapters of life. Therefore, a key component of hospice care is adequate pain management, including both physical pain and emotional pain. Effective pain relief helps to create a comfortable, peaceful environment that enhances the quality of life as much as possible for patients who are nearing the end of life.
Understanding Pain Management in Hospice Care
Hospice care is specialized care intended to provide comfort and support to patients who are nearing the end of life, such as terminally ill patients. Most hospice patients transition to this type of care when they have a life expectancy of fewer than six months. One of the primary goals of hospice care is pain management. Pain management helps to support the highest quality of life for whatever time remains.
However, pain can be one of the most challenging symptoms to manage, especially when caring for a loved one. Many hospice patients report untreated or undertreated pain despite available treatments. A professional hospice care team can create effective pain management strategies and help caregivers implement these plans.
Pain Assessment
The first step in managing pain is to perform a pain assessment. Inadequate pain assessment can be a barrier to effective pain control. A comprehensive pain assessment includes location, intensity, quality, onset, duration and factors that exacerbate or alleviate it. The gold standard of pain assessment is the patient’s self-reported pain.
Several pain scales are used, including a pain rating scale that asks patients to rate pain from 0 to 10, with 0 representing no pain and 10 representing the most severe pain imaginable. In addition, a health care provider may ask a terminally ill patient the following questions to assess pain:
- Where is your pain?
- When did your pain begin?
- What words would you use to describe the pain?
- What does the pain feel like?
- How does the pain affect your life?
- How intense is the pain?
It’s also important to use behavioral pain tools, such as the Pain Assessment in Advanced Dementia, the Behavioral Pain Scale and the Critical Care Pain Observation Tool to assess pain because cognition decreases as the end of life nears. These tools can help assess pain in patients who are sedated or intubated based on facial expressions, muscle tension and movement. Some signs and symptoms of pain a nonverbal patient may exhibit include:
- Appearing tense and uneasy, perhaps drawing their legs up or kicking
- Facial grimacing or frowning
- Guarding the area of pain or withdrawing from touch to that area
- Moaning, groaning or whimpering
- Restlessness and agitation
- Writhing or constant shifting in bed
Furthermore, pain should be assessed regularly. When patients can’t communicate effectively, caregivers may be interviewed to assess a patient’s pain.
Pain Relief With Medication
There are many treatments available for pain management for end-of-life symptoms. Medication remains the mainstay of treatment for pain at the end of life. Below are some of the most common medications used at the end of life to manage pain.
Non-Opioid Painkillers
According to the World Health Organization, the first step in treating pain in patients with a terminal illness is to use nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are a common treatment approach for mild to moderate pain. Most people are familiar with over-the-counter, nonprescription NSAIDs, such as aspirin and ibuprofen. A health care provider may also prescribe stronger NSAIDs if over-the-counter NSAIDs are ineffective. In addition, acetaminophen may be used as an alternative to NSAIDs.
Opioid Painkillers
Many hospice patients have high levels of pain that NSAIDs can’t address. These patients often require the use of opioid medicines, the principal class of painkillers used at the end of life. For most patients with a terminal illness, opioid therapies provide the greatest pain relief. Opioids work to control pain by blocking pain messages sent from the body through the spinal cord to the brain. A wide range of opioid medications is available and can be taken in a variety of ways. Opioid drugs typically used in the hospice setting include:
- Fentanyl
- Hydromorphone
- Methadone
- Morphine
- Oxycodone
One drawback of opioid pain medicines is that a patient will develop a tolerance to the medication over time and will need higher doses to get the same effect. A hospice care team may address this issue by changing the type, the dose or the way the medication is administered.
Misconceptions About Hospice Pain Management
The prospect of a loved one taking pain medication until the end of life may raise questions for family caregivers. Some may worry about the side effects of painkillers, such as excessive confusion and drowsiness. Keep in mind that health care providers are trained to reach a favorable balance between pain relief and side effects. Patients are also monitored closely to ensure they’re receiving dosages that address their pain while minimizing side effects.
Family caregivers may also worry about the dangers of addiction, given the headlines about the opioid epidemic. These concerns are valid among the general population. However, it’s important to recognize that the priority in a hospice patient’s life is allowing them to live their final days in as much comfort and peace as possible. Effective pain relief plays a significant role in enhancing their quality of life.
Contact PRN Hospice for Support
At PRN Hospice, our team’s mission is to ensure a comfortable end-of-life experience by providing compassionate care that includes effective pain management to patients living with an end-stage illness. Our hospice team consists of skilled medical professionals, including physicians, registered nurses, licensed vocational nurses and certified hospice aides. We also offer social workers, chaplains, volunteer coordinators, volunteers and bereavement coordinators for additional social, emotional and support services. Contact us today to learn more about pain management and hospice care.