Pain Management and Quality Hospice Care

Expertise in Pain Management and Quality Hospice Care

“Palliative Care is the treatment that enhances, comforts, and improves the quality of a person’s life. The test of palliative treatment lies in the agreement by the individual, the physician, the primary caregiver, and the hospice team that the expected outcome is relief from distressing symptoms, easing of pain, and enhancement of the quality of life.”

It isn’t easy to talk about death, even with those who are closest to us. But reluctance to talk about the care we want at the end of life may rob us of the chance to choose, should we be faced one day with a terminal illness. Unfortunately, most seriously ill Americans do not receive the end-of-life care they want, largely because they do not realize that hospice employs a team of doctors, nurses, social workers, chaplains, and trained volunteers to help the individual and his loved ones with their whole range of needs – physical, emotional, social, and spiritual.

Americans clearly state their end of life priorities:

* Home-based treatment
* Control over their treatment
* Emotional and spiritual support for themselves and loved ones
* Freedom from financial worries
* Effective pain management

Expertise in pain management is the absolute essence of hospice and palliative care. An individual facing the end of life is suffering in all dimensions of their being, and physical pain may be a very small part of the total suffering being experienced, although it affects all other aspects of a person’s well-being and vice versa.

As the intensity of an area of suffering (physical, emotional, or both) increases for the dying person, all other areas are often affected by that escalation. For example, if a person’s physical pain is out of control, that individual mentally cannot be at ease, nor can they pray or meditate as they might like, nor are their emotions going to be as stable. In the same light, if the person’s emotions are in upheaval, that individual may find a need for increased medications as the mental stress is now affecting the level of pain.

According to recent studies, a high percentage of older Americans experience ongoing or intense pain, and few receive adequate pain medication. Unmanaged pain causes increased misery, can lead to anxiety and depression, and cause an elderly person to withdraw from social contact. In addition to psychosocial trauma, unmanaged pain can eventually lead to an increase in falls, immobility, sleep loss, and decreased appetite.

Modalities for treating pain can be divided into nonpharmacologic treatments such as heat, cold, biofeedback, hypnosis, or acupuncture, and pharmacologic treatment ranging from aspirin and non-steroidal anti-inflammatory drugs to opioid narcotics. These same studies additionally cite significant barriers to pain management:
* Age: the older you are, the less likely you are to receive pain medicine.
* Ethnicity: minorities are more likely to be under treated.
* Ability to communicate: healthcare providers find it more difficult to detect pain in a nonverbal or otherwise cognitively compromised person, including those with memory loss.
* Lack of reporting: some elderly believe that pain is a part of aging, or they try to ignore it for fear it signals progression of their disease. Others keep silent about their pain rather than “bother” their caregiver.
* Interactive complications: multiple medical problems, drug interactions, or medication side effects can mask pain symptoms.
* Fear of addiction / Financial concerns.

General principles for prescribing pain control medication in the elderly include:

* Administering medication on a routine schedule.
* Use the least invasive route of administration first.
* Begin with a low dose. Increase carefully until comfort is achieved.
* Reassess and adjust frequently to optimize pain relief and manage potential side effects.

The interdisciplinary team approach used for pain management and quality hospice to care for the dying person creates a setting in which that individual and their loved ones can take advantage of the expertise of a variety of professionals and support systems. The team members are trained to assist both in identifying the suffering being experienced and utilizing interventions to alleviate the suffering in any one area, and thus, in the overall well-being of that person.