Pain Management at the End of Life

Big Ideas:

1. There are two different types of pain [1:49] – Both types of pain require different treatments to control. Somatic pain is the most common type that requires narcotic medication to treat. Nerve pain is the second type of pain. Narcotic medication does not work in the treatment of nerve pain, and it is often missed. Nerve pain requires nerve medication – gabapentin (also known as Neurontin) is the most common medication used for never pain management. Stabbing or burning pain, often localized in the feet and head is indicative of nerve pain. Quality of life for patients is directly related to pain management.

 

2. The Hospice Comfort Kit [7:30] – Hospice provides a comfort kit for family caregivers filled with the most common medications used at the end of life to manage pain, breathing difficulties, and other common causes of discomfort. Have this comfort kit within 24 hours of the patient being placed on Hospice. If you encounter a need for medication to address pain or breathing issues and you do not have it available, it will lead to a stressful (and avoidable) situation for everyone. Once on Hospice we know there is going to be a decline in patient condition – but we don’t know at what rate the decline will occur. Being prepared for this decline to happen quickly is essential. Pick one person in the family that will be in charge of administering medications – this should be whoever is most comfortable doing so. Have the Hospice nurse go over the medication in the comfort kit with the caregiver and practice administering medications and understanding the comfort kit on each visit until it is well understood. Trying to figure out what to use and how to administer it during a crisis situation is not the way to do it.

 

3. Understanding the Pain Scale [11:16] – The pain scale is typically assessed by 1 to 10. 1 is no pain and 10 is the most pain a person can possibly be in. Pain is subjective. Pain needs to be kept at a 4 or below for optimal quality of life each day. When pain is going up, you have to stop that pain on its incline or control it because if it gets too high it will be almost impossible to bring down – this is how the human body works. Patients will sometimes hold off on taking medication until they really need it because it is something they still have control over, but it is too late if their pain is already too high. Assess their pain regularly and keep a logbook of their pain levels pre-medication and 45 minutes post-medication. You can’t take medicine out of somebody, so administer pain medications incrementally until you reach a therapeutic space – defined as a 4 or below on the pain scale.

 

 

4. Keep Track of Patient Bowel Movements [16:30] – This is important because narcotics are known to be constipating – they slow the stimulation of our gastrointestinal tract and our ability to have regular bowel movements. You want to get ahead of this problem as a caregiver. The patient should relieve themselves every one to two days for comfort purposes – it can turn into a crisis situation if they become constipated for an extended period of time. Stool softeners and laxatives should be included on the medication administration page of your Hospice comfort kit.

 

5. Pain Management at the End of Life and Addiction [22:01] – There are many misconceptions about this topic and the lack of knowledge often leads to unnecessary suffering. Addiction often occurs in people who have a pre-disposition to it within their biochemistry or when a person abuses drugs recreationally to achieve a euphoric state – when there is no underlying pain to manage. At end of life, these should not be major concerns – especially because the medications should be controlled with the goal of keeping their pain at a 4 or below and assessing regularly. This person is going to have their end of life, and they’re either going to have it being comfortable and having their pain managed – or suffering and having a lot of pain. Pain management is neither going to prevent the end of life or hasten the end of life – it’s a question of them either being comfortable in this last phase of their life or being in pain and suffering in this last phase. Addiction is a medical condition that requires us to reserve judgment and lead with compassion. It is not a justifiable reason to withhold medication at end of life – keep the medicine locked away and control it to avoid issues. Our job is to be present, be loving, and to support this person at the end of their life – no matter what their past has been. Everyone deserves to be comfortable at end of life.

 

Memorable Quotes:

1. “The rule of thumb for medication and pain management is that on a pain scale of 1 to 10 – 1 being no pain and 10 being the most pain somebody can possibly be in – you want that pain to be kept at a 4 or below.” – Suzanne B. O’Brien RN

 

2. “We know that end of life is really hard on everyone. Everyone in the family is touched by end of life and all people are probably having different experiences.” – Suzanne B. O’Brien RN

 

 

3. “Pain management is not about completely eliminating pain. It is about controlling it well enough so that it is not causing every second of every day to be defined by suffering and a lack of quality of life.” – Suzanne B. O’Brien RN

Resources:  – GET THE FREE DEATH DOULA GUIDE HERE: HERE

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xo Suzanne