End of Life Pain Management

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End of life pain and end of life care are sensitive topics. Often, when a person is at the end of their life, they are in debilitating, excruciating pain, and their families and loved ones are at a loss for what to do to make their last days comfortable and peaceful. Not only is it psychologically and physically unbearable for the sufferer, their families and loved ones often feel the psychological strain of watching their loved one pass in intense pain.
Many feel that there is nothing they can do; either that they will suffer until death comes, or watch the same happen to a loved one. Some feel that they will be seen as weak or complaining if they bring up how miserably in pain they are. Some are afraid that if they ask for pain relief methodology, all work toward curing them of what is killing them will be stopped, and they will merely be made to be comfortable at the end.
End of life patients often want to be in their homes surrounded by family and loved ones, but it is sometimes indicated that a patient needs ongoing medical care that is outside the scope of medically-untrained family members. In these cases, a home care nurse may be the help that is needed; in more severe pain management cases, the only solution is to place the patient into hospice care.

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The best and most recommended end of life pain management involves non-pharmacologic approaches. Raj’s Practical Management of Pain brings to light the strong emotional bond that can be created between the end of life patient and their family members, loved ones, and caregivers. These approaches can comfort the patient while empowering the family members, as they feel they are doing something to help.
Family members can be taught how to perform or assist in safe, simple, therapeutic modalities such as massage and light physical therapy. Music therapy is becoming widely accepted as a functional therapy, and simply reading a favorite book to an end of life patient can effectively lower their blood pressure and increase their sense of well-being and contentment. Often, knowing that someone is there helps immensely.
For some patients that are ever nearing the end of their lives, the only reduction of pain may in fact be pharmacological options. While it is always safest and best to begin with over-the-counter medications, for those suffering from end of life pain, the immediate jump to prescription pain medications may be indicated. However, some end of life pain sufferers are hesitant to rely on medications to control their pain, as their impression and reputation is important to them. They do not want to be seen by family members and caregivers as “drug-seekers” or dependent and/or addicted to pain medications. It should be carefully explained by the treating physician the impact of the prescription pain medications and the perceived stigma that may come with them.
The starting point for pharmacological therapy may be non-steroidal anti-inflammatory drugs or NSAIDs. NSAIDs are useful for treating any kind of pain that is mitigated by inflammation, including inflammation that is directly caused by cancer. Common NSAIDs include ibuprofen and naproxen.
Acetaminophen is commonly known by the brand name of Tylenol and is one of the safest pain relievers to take on a continuing basis as it is so mild. It can be beneficial both for less severe pain and to supplement other methodologies in the reduction of severe pain.
Opiods(also known as narcotics) are prescription pain medications and include morphine and oxycodone among other potent medications. These strong medications do have side effects and should only be taken under the prescription and advisement of a treating physician.
In addition, antidepressants may be prescribed to an end of life patient. Antidepressants have not only been shown to elevate the mood and well-being of an end of life patient but have also been seen to have some analgesic (pain relieving) effects.
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 There is evidence that show that suffering from severe pain may actually hasten death due to a number of factors including but not limited to stress on the body’s systems, and a reduced ability to move that increases the chance for a deadly embolism or pneumonia. In addition, due to the fact that the patient is not only facing the end of their life but also a decrease in the quality of what life they have left, the patient can feel a sense of spiritual despair, severe depression, and no emotional well-being whatsoever.

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No matter what an end of life patient and their family members decide, it is important to find a treating physician who understands the patient’s wishes regarding end of life pain management and is interested in providing that person with a dignified, pain-free, and comfortable death.