All About Pain

What is pain?

Pain is private. In 1984, pain research expert Margo McCafferty defined pain as "whatever the experiencing person says it is, existing whenever he says it does". Only the person having pain knows how it feels. so we must ask the person in pain how they feel and listen to their answer.

Sources of pain

Some pain comes from physical trauma (i.e. - a cut on the knee, damage to a nerve or a tumor growing inside the body). Other sources of pain are emotional or spiritual concerns (i.e. - loneliness, anxiety, stress or fear of the unknown). Whatever the source of pain, we must offer the person in pain quick and effective relief.

Pain in the elderly

Some people think that having pain is just a part of getting older and should be accepted. However, pain is meant to alert you that something is wrong and needs to be corrected, whenever possible. As we age, we develop more health problems and some of these problems, like arthritis, bring pain with them that is not easily relieved. Nevertheless, we need to try different treatments to relieve the pain, especially when facing advanced illness.

Pain in those with dementia

A person with dementia, like Alzheimer's disease, does not lose their capacity to feel pain, only their ability to tell you they are in pain. Often in a person with dementia, pain is expressed as agitation, anxiety, or combativeness. There are behavioral clues we can consider to evaluate if a person is in pain. If your loved one has dementia discuss your perceptions of their pain with your hospice nurse.

Non-drug ways to ease pain

Some pain is due to being chair or bedbound. Simple range of motion exercises or a gentle massage that you can do for your loved one will relieve the pain of muscle and joint stiffness. To ease emotional or spiritual pain, discuss these concerns with the hospice social worker or chaplain. Complementary therapy helps many patients experience relief from multiple sources of pain. Examples include massage therapy, reflexology, music therapy, and aroma therapy.

Medications to ease pain

Sometimes medications are needed to relieve pain. Some of these drugs may be narcotics, like morphine or codeine. Many people misunderstand the benefits and risks associated with narcotics.

What you can do to ease pain

  • Do not wait for pain to become a problem. The longer pain goes untreated, the harder it is to ease.
  • Give pain relief medication as soon as pain begins.
  • Give pain relief medication exactly as instructed by the hospice nurse.
  • Give pain relief medications around the clock on the schedule set up by the hospice nurse.
  • Take the breakthrough (“as needed”) pain relief medications when needed and as instructed by the hospice nurse.
  • Be informed about the pain relief medicines prescribed for your loved one. Ask questions of the hospice nurse.
  • Call hospice any time of day or night for any moderate or severe pain.

Will I become addicted to narcotics?

Many people fear that any use of narcotics will result in addiction. Addiction is the constant craving for an excited feeling from a drug, despite self-harm. However, numerous research studies show that people who take narcotics to relieve their pain do not become addicted.

Physical dependence

People who use narcotics do become physically dependent upon the medication after prolonged use. Therefore, they cannot abruptly stop taking the narcotic without causing their body to experience some physical side effects. If your loved one uses a narcotic to ease their pain, do not stop this important medication without discussing this with your hospice nurse. Should the pain go away, we can gradually reduce their use of the drug without causing the side effects from physical dependence.

Will I develop a tolerance to narcotics?

Some people ask, “if I start using narcotics now, what will I do when the pain gets really bad?” Pain does not always worsen. In addition, narcotics, like morphine, have no limit on how much can be taken safely as long as the increase is gradual. Your loved one receives whatever dose they need to relieve their pain. Your hospice nurse will work with you to adjust the medication to provide your loved one with good pain relief and the fewest side effects.

Is death always painful?

Many people die without having any pain. If pain occurs, there are many options to relieve it safely and rapidly.

Do narcotics hasten death?

Narcotics relieve pain. When death occurs it is due to the progression of the basic disease, not due to pain relief medications. Giving narcotics close to the time of death ensures that your loved one remains comfortable.

Does pain mean I am getting sicker?

It is a common fear that the worsening of pain means that your loved one is getting sicker or that death is near. Pain needs to be treated whenever it is present. The use of narcotics does not lead to death. A narcotic, like morphine, eases pain, but also makes breathing easier, allows for relaxation, improves sleep, and increases your loved ones comfort. Also, it is not the spread of the disease, but the level of pain that dictates which medicine to use.

Will narcotics stop my breathing?

If your loved one needs to use a narcotic for pain relief, your hospice nurse will start with a low dose and gradually increase the medication until your loved one is comfortable. Breathing problems, secondary to narcotic use, rarely occur. Narcotics, given under the direction of the doctor and the hospice nurse, will not cause your loved one to stop breathing. In fact, morphine eases breathing difficulties in diseases like heart failure, asthma, and emphysema (COPD).

Common side effects of narcotics

Sedation
When first starting on a narcotic, your loved one may feel some increased sleepiness (sedation) for 1 to 3 days. The body quickly adapts to the new medication and the sleepiness will not last. In addition, if your loved one had pain for awhile, they may need to catch up on their sleep.

Constipation
The most common side effect from using narcotics is difficulty moving the bowels (constipation). This is easily controlled with the use of a stimulant laxative.

Upset Stomach
Another possible side effect is an upset stomach (nausea). Should this occur, your loved one can use a medication called an anti-emetic to relieve that feeling.

Discuss any concerns about side effects with your hospice nurse.

Commonly used drugs

Acetaminophen
Acetaminophen (common brand name is Tylenol) is an over-the-counter, non-narcotic medication that is well tolerated by the elderly. Do not take more than 3 grams (or 3000 mg) in a 24 hour period.

Codeine
Codeine is a narcotic used to treat mild to moderate pain. It is more constipating than morphine.

Fentanyl
This narcotic drug is available as a thin, adhesive patch applied to and absorbed through dry, non-hairy skin. It is useful for people having difficulty swallowing. Fentanyl provides a continual low dose of the drug for continual pain relief. A common brand name is Duragesic.

Morphine
Morphine is the narcotic drug of choice for the relief of moderate to severe pain. Morphine works by changing the way the body senses pain. It is well tolerated, with few side effects. Morphine comes in various forms: tablet, liquid, and rectal suppository. In addition, morphine is available in immediate release (every 4-hour dosing) and time-release (every 8-12 hour dosing) tablets and capsules. Common brand names for morphine are MS Contin, Oramorph, and Roxanol.

Oxycodone
Oxycodone is a narcotic drug used for the relief of moderate to severe pain. It is available as a liquid or tablet to be taken by mouth. Common brand names are Oxycontin, OxyFast, OxyIR (immediate release), and Roxicodone.

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