Why do so many hospice patients have pain?
Many factors contribute to discomfort in hospice patients. Diseases like cancer, osteoporosis or circulatory problems are all known to be very painful. For others, just being sick and having to lie in bed all the time causes pain. These patients are suffering from progressive illnesses which are likely to cause increasing amounts of pain or discomfort. Our bodies are full of muscles, bones and joints which are designed to keep us moving. If we are inactive, our muscles stiffen and ache. This is why a good stretch in the morning feels so good. Immobility almost always causes discomfort and progressive diseases usually cause increasing amounts of pain.
Who are the people who help treat pain?
Managing the pain of a hospice patient is a team effort. Careful interview of the patient and/or caregiver is necessary. Usually this is done by the hospice nurse. She will interview the patient and/or caregiver about what pain medication is given, when it is given and if it is working at controlling the pain. The nurse will then share this information with a hospice pharmacist and the physician which will order the medication best suited to treat the patient. Hospice pharmacists are wonderful resources to the hospice team. They know the medications the best and provide invaluable information to the nurse and the physician.
Why use long acting pain medications?
Patients who suffer from continuous pain are best treated with some kind of long acting pain medication. Examples of these include tablets which are swallowed and then dissolve slowly in the stomach or medication on a patch which is applied to the skin which release continuous amounts of pain medication or IV medication.
Can patients on long acting pain medications safely use short acting pain medications too?
Most patients who use long acting pain meds use short acting pain medications for "breakthrough pain". This is pain that "breaks through" the barrier of the long acting medication. The patient may be pain free while lying still but they hurt when they are turned or transferred. Any patient using long acting pain meds can safely use short acting medications.
Should I be worried about "addiction"?
There is a difference between being addicted and being dependent on a medication. People who are addicted take the pain medication because they like the side affects of the drug. People who are dependent take the medication because they have the medical problem that the medication successfully treats. If a patient takes their prescribed pain medication to treat or prevent pain, they are "dependent" on that medication. Just as a diabetic patient would be "dependent" on their insulin or an epileptic is "dependent" on their seizure medication. No one accuses a diabetic of being "addicted" to their insulin.
How can I help my loved one be pain free?
Many patients, particularly elderly patients are reluctant to take pain meds. Caregivers can help by observing for non verbal symptoms of pain like grimaces or moaning. When these symptoms are noted, they should offer medication or of a patient is reluctant, just bring in some analgesic and tell the patient, its time for some medication.
Should I be worried about using too much pain meds?
In reality, most patients are under medicated. Look at the patient. Are they comfortable? Are they sleeping with a peaceful look on their face? Can they transfer without signs of discomfort? If yes, the patient is perfectly medicated. Many times, people are so worried about over using pain meds that they under use the medications. If the label states you can give "10 to 20 mgs" and the patient isn't comfortable after giving 10mg then give them 10mg more. Communicate with the doctor or nurse if you are using the maximum amount of the medication and the patient is not getting relief. Look at the patient. Medicate what you see. If you are trying to force medication down the throat of a patient who is sleeping or sedating, then you are over medicating. Always use your hospice nurse to help you so you and the patient are comfortable.
Should I keep a record of what medications I'm giving?
Yes. Write down the dose and the time. Your hospice nurse will use this record when she goes the doctor to adjust pain medications.
Mom can't swallow, are there other ways to medicate her?
We can give comfort medications IV, rubbed into the skin as a cream, through an inhaler, through a patch on the skin, under the tongue or even rectally. There are lots of options. Talk to your doctor or hospice nurse. The goal of hospice is the comfort and safety of the patient. Communicate with the hospice nurse or your doctor if you have any questions or if you don't think your loved one is comfortable. We are there to help you.