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Myths and facts about pain medication
The
fear and reality of pain are often major concerns at the end
of life. There have been many advances in pain treatment; however
there are still many myths that may prevent patients and family
from seeking and/or accepting pain medication.
It
is important to encourage patients to be honest and accurate
in reporting their symptoms. The majority of patients report
less pain than they actually feel. This may be due to
cultural or personal beliefs, for instance, " I shouldn’t
complain." Trained hospice social workers, nurses, and/or
palliative care specialists may be especially helpful in working
with patients who hold these beliefs.
Fear
of addiction or dependency may prevent patients from taking
adequate medication to treat their pain. These fears also may
prevent family caregivers from giving needed medications. In
reality, addiction (which is psychological or emotional
dependency) is a rare occurrence when narcotics are used for
the purpose of treating pain. Tolerance, or physical dependence,
may occur. However, it is difficult to know if the need for
increasing dosages is a developing resistance to the drug or
rather the disease simply getting worse. Either way, in the
context of a life threatening illness, increased pain probably
indicates a need to increase dosage.
There
is no ceiling on the dosage of narcotic medicines for the terminally
ill. One is limited only by the occurrence of side
effects, which might range from none to severe. Open
and honest communication with the patient's physician and nurse
is essential to ongoing, effective pain management. (Return
to list)
Types of pain medicine
There
are two basic types of pain medication: non-narcotic, used
to treat mild pain; and narcotic, which is used to treat more
severe pain. Acetaminophen (e.g., Tylenol) and aspirin are
the most common non-narcotic pain medications. They are available
without prescription and are also useful in the treatment
of fevers. Morphine is an example of a narcotic pain medication.
Many medications, for example Vicodin, combine a mild narcotic
with a non-narcotic pain reliever such as acetaminophen. Patients
who take both non-narcotic and narcotic medications must check
with their pharmacists, physicians, or nurses to avoid harmful
effects.
Ongoing pain is best managed
with a scheduled, long-acting medication in combination with
a short-acting medication that can be taken for breakthrough
pain. Typically, this involves a morphine patch that sticks
to the skin and administers pain medicine over a 12-48 hour
period, with pills available to take for immediate relief
if the pain "spikes" and breaks through the effects
of the patch. (Return to list)
Side effects of narcotic medication
Constipation
is a very common side effect of pain medication and is usually
treated with dietary changes, and/or over the counter medications
such as stool softeners. Nausea is also common and may require
a prescribed medication. Ask your doctor or call your hospice
nurse for the best treatment options.
Initially,
a patient may sleep heavily and appear sedated. This is not
uncommon and usually subsides once the patient has a chance
to rest and adjust to the new medication. If the patient continues
to sleep a lot, the doctor should be consulted regarding the
appropriate dosage and whether or not a change in medication
may be warranted. It is always important to remember that
whenever possible, the patient should have the primary voice
in discussing any and all treatment options. If the patient
prefers to sleep rather than experience pain, this is to be
respected. (Return to list)
Pain relief without medicines
In
addition to medicines, patients and their caregivers can utilize
a variety of non-pharmacological comfort measures. These include
hot or cold compresses, massage, or position change. There
are also distraction techniques, such as meditation/visualization,
music, television or videos. There are books and tapes available
to help with non-medicinal forms of pain relief. Be aware
that when distraction helps, it does not mean the pain
was not real to begin with. Distraction simply blocks the
pathway of the nerves leading to the brain and, thankfully,
keeps the brain from registering discomfort.
If
you are looking for other non-pharmacological approaches to
pain management, you might want to consult complimentary medical
practitioners such as the chiropractors, osteopaths and acupuncturists
involved in the Pain Society of Oregon. These professionals
often have treatments that can help. (Return
to list)
Further resources
We
suggest you go to the websites sponsored by "Growth
House" and the Department
of Pain Medicine and Palliative Care at Beth Israel Hospital
in New York. (Return to list)
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