Pain management at the end of life can be confusing and scary. There are a lot of misconceptions about pain medications. Understanding the different types of pain, medications, and how the medications work is the key to successful pain management. The following are some common questions associated with pain and pain management:
What are the two most common types of pain during end of life?
Somatic Pain:
Generally a deep pain coming from within in the skeletal structures, muscles, tendons. It can be sharp, cramping, or aching pain. Somatic pain is generally treated with narcotic medications.
Nerve Pain:
Nerve paid affects the nerves that carry sensation to the brain. It is generally described as a burning pain. It is very different from Somatic pain and is treated with completely different medications. It is more common with patients who are being treated with chemotherapy. Narcotic medications do not relieve nerve pain.
It can be helpful to keep a log book documenting the type of discomfort someone is experiencing, the level of pain (1-10), and when it is happening.
How will I get pain medications at the end of life?
If you are receiving hospice services at home, they will provide you with a comfort kit that includes the most common medications used during end of life. I recommend having one main caregiver familiarize themselves with the medications, including how and when to use them. Your loved ones nurse will schedule time with you to explain how to administer the medications to ease your concerns.
The medications are color coded to help eliminate confusion. Never be afraid to ask questions so that you feel comfortable with administering medications to your loved one.
How do I keep track of when my loved one is getting medication:
Keep a log book next to the bed, and document when medication was give, how much was given, and its effect. This is an important tool for the nurse as it helps him/her to evaluate the medications, dosage, and frequency necessary to control pain. It is also helpful if the main caregiver is not present when medication needs to be given.
The goal is to keep the pain level at a 4 or below. It is much easier to control pain before it gets too high. Once the pain level reaches an intolerable point, it takes more medication to reach a level of comfort. Pain medication given in the correct dosage provides individuals with a better quality of life.
Can I get addicted to my pain medication?
The short answer is no. People who are in pain do not get addicted to their pain medication at the end of life. The brain recognizes pain and works to control it and taking medication does not provide a feeling of euphoria.
What if I had a previous problem with addiction?
Even if someone has had a previous experience with addiction, they should not be in pain at the end of life. Be honest with your hospice nurse, and they will work with you to carefully control the amount of medication being given.
If someone else in the home is experiencing a problem with addiction, the medication can be kept in a secure location such as a locked box.
Other things to keep in mind is that pain medication can cause constipation. I recommend keeping a log book of your loved one’s bowel movements. Medication can be given to relive constipation before it becomes a problem. Pain medication can also cause dizziness. In order to prevent falls, always instruct your loved ones to get up slowly and make sure they do not feel lightheaded before moving around.
Always remember to say: I love you, thank you, forgive me, I forgive you, I will miss you. We only have one chance at the end of life, so make every moment count!
Judith Arasi - End of Life Doula 