People often express more fear about dying in pain, than death itself. In fact, researchers have consistently demonstrated that pain control is often inadequate for those who are dying. However, pain is not simple to define. Two people with similar conditions may react very differently, with 1 person reporting pain at level "3" on a 1-10 scale and another reporting pain at level "8." How then do healthcare workers determine the level of pain? Is one person right and the other wrong about the level of pain? Is there a right or a wrong at all? Should healthcare workers worry about people at the end of life becoming addicted?
These are not simple questions, but a good starting point is: Assume that pain is what the person experiencing it says it is, taking into consideration that many physical, psychological, social, and spiritual issues can affect pain. Despite the availability of pain medicines, many people still die with their pain uncontrolled, and that is a failure of the healthcare providers. There are many drugs that can and should be used to control pain and symptoms:
Adjuvant drugs may be added
to calm fears or anxiety or control side effects of medications. The WHO and
other researchers recommend that drugs be given around the clock (every 3 to
6 hours) to prevent breakthrough pain rather than on demand to prevent
the recurrence of pain. This approach to pain control is 80% to 90% effective.
If pain continues to break through, the dosage of medication needs to be retitrated
upward or other methods, such as nerve block, need to be considered. As body
systems begin to fail, especially renal and hepatic failure, medications may
need to be altered, with shorter acting opioids or rotation of opioids. If patients
are not able to speak and express the degree of their pain, then indications
of suffering, such as moaning, or stiffening when moved, should be considered
as evidence of pain.
in End-of-Life Care, an international journal of leaders in end-of-life
care, has provided a number of useful tools on it's website. Medication references,
include Opioid Reference Table, Adjuvant Analgesics,
and Side Effects Management. Click
here to download in PDF format.
As well as primary pain analgesics, patients may frequently also need adjuvant medications for various unrelieved symptoms, or medications for side effects:
Sometimes neural ablation
(nerve block) can relieve pain for some conditions, and this may allow the patient
to have relief of suffering and still retain consciousness as long as possible.
More commonly, neuraxial analgesia has been used with intraspinal therapy (intrathecal
and epidural) to relieve intractable pain.
RnCeus Homepage | Course catalog | Discount prices | Login | Nursing jobs | Help