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Palliative care - managing pain

End of life - pain management; Hospice - pain management

 

Palliative Care

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses.

When You Have Pain

 

One of the problems a serious illness can cause is pain. No one can look at you and know how much pain you have. Only you can feel and describe your pain.

Pain that is always or almost always present can lead to lack of sleep, depression, or anxiety. These can make it harder to do things or go places, and harder to enjoy life. Pain can be stressful for you and your family. But with treatment, pain can be managed.

 

How Pain is Measured

 

First, your health care provider will find out:

  • What is causing the pain
  • How much pain you have
  • What your pain feels like
  • What makes your pain worse
  • What makes your pain better
  • When you have pain

You can tell your provider how much pain you have by measuring it on a scale from 0 (no pain) to 10 (the worst pain possible). You choose the number that describes how much pain you have now. You can do this before and after treatments, so you and your health care team can tell how well your treatment works.

 

How Pain is Treated

 

There are many treatments for pain. Which treatment is best for you depends on the cause and amount of your pain. Several treatments may be used at the same time for the best pain relief. These include:

  • Thinking about something else so you are not thinking about the pain, such as playing a game or watching TV
  • Mind-body therapies such as deep breathing, relaxing, or meditation
  • Ice packs, heating pads, biofeedback, acupuncture, or massage

You can also take medicines, such as:

  • Acetaminophen (Tylenol)
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin), diclofenac
  • Narcotics or opioids, such as codeine, morphine, oxycodone, or fentanyl
  • Medicines that work on the nerves, such as gabapentin and pregablin

 

What You Can Do

 

Understand your medicines, how much to take, and when to take them.

  • DO NOT take less or more medicine than prescribed.
  • DO NOT take your medicines more often.
  • If you are thinking about not taking a medicine, talk to your provider first. You may need to take a lower dose over time before you can stop safely.

If you have concerns about your pain medicine, talk to your provider.

  • If the medicine you take does not relieve your pain, a different one may help.
  • Side effects, such as drowsiness, may get better over time.
  • Other side effects, such as hard dry stools, can be treated.

Some people who take narcotics for pain become dependent on them. If you are concerned about this, talk to your provider.

 

When to Call the Doctor

 

Call your provider if your pain is not well controlled or if you have side effects from your pain treatments.

 

 

References

Abernethy AP, Kamal A, Currow DC. When should nonsteroidal antiinflammatory drugs be used to manage pain? In: Goldstein NE, Morrison RS, eds. Evidence-Based Practice of Palliative Medicine. Philadelphia, PA: Elsevier; 2013:chap 10.

Ellershaw JE, Dickman A. Pain control in the care of the dying. In: McMahon SB, Koltzenburg M, Tracey I, Turk DC, eds. Wall and Melzack's Textbook of Pain. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 76.

 

        A Closer Look

         

        Talking to your MD

         

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            Review Date: 2/6/2016

            Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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