Pain Management Options During Palliative and Hospice Care
Natasha Weiss
Pain Management Options During Palliative and Hospice Care
As heartbreaking as it is, death is a part of life, and having the right tools allows people to navigate their end-of-life care with as much comfort and support as possible. Knowing your options allows you and your loved ones to make informed and empowered decisions during this difficult time.
A key component of hospice and palliative care is pain management. Still, with so many options out there it can be difficult to know what the right option is for each person’s needs. Let’s take a closer look at what pain management options are available during hospice and palliative care.
What’s The Difference Between Hospice and Palliative Care?
Two terms you hear used often are hospice and palliative care – so what’s the difference between them?
When looking at hospice vs palliative care one of the main differences is how much longer a person is expected to live. They both aim to provide physical and emotional support for someone who is receiving care, however, there are a few key differences.
Hospice is intended for people who are likely to die within 6 months, while palliative care can last for any period from weeks to years. Palliative care provides support for people with life-threatening illnesses, which may include treatments that are aiming to cure the disease or ailment. Hospice services are a form of palliative care that focuses on symptom relief, not curing.
What they both have in common is comfort. How much can someone’s symptoms be relieved? How can this person soothe their discomfort as much as possible during this transition? That’s where pain management comes in.
Types of Pain Management in End-Of-Life Care
Medical advances have given providers and the people they treat more options than ever when it comes to pain management. Whether someone is in the hospital receiving palliative care or is going through hospice at home (or vice versa) – there are pain management options available for everyone who is dying or navigating a life-threatening illness.
The World Health Organization (WHO) created the analgesic ladder to outline one strategy that can be used to treat pain in cancer patients. It has since been adapted and is used to treat patients with a wide variety of diseases.
- Mild pain is treated using non-opioid medications like NSAIDs or acetaminophen.
- Moderate pain is treated with weak opioids, this may be in addition to the ones used in step one.
- Severe pain is treated using potent opioids.
Although this approach has some flaws, it is a helpful guideline for administering analgesics for pain relief during end-of-life care.
Pain Assessment
The first step when figuring out a pain management plan is to assess someone’s discomfort. There are several scales available that providers use to help gauge how much pain a patient is in. These are important for all patients, but especially for those who are unable to communicate or self-report their pain – as their discomfort can go undertreated.
Pain is evaluated regularly, and their symptom management plan is updated accordingly. This plan may include a combination of tools and medications:
OTC pain relief
Over-the-counter pain medications are an accessible and affordable tool for people navigating palliative care. These include NSAIDs like ibuprofen and naproxen, and acetaminophen commonly found in Tylenol.
Although they’re available in stores, it’s important to discuss with your or your loved one’s provider about any potential contraindications when it comes to OTC analgesics and other medications they’re on. Additionally, healthcare providers may prescribe stronger versions of these medications.
Prescription pain relief
Providers may turn to other types of medications to help ease symptoms. Some types of prescription pain management options that are used during palliative care include:
- Muscle relaxants: For pain triggered by muscle spasms or tension.
- Steroids: Highly effective in reducing pain caused by inflammation.
- Local anesthetics: Used to block pain signals in a specific area of the body.
- Anticonvulsants: Seizure medications can be useful in helping to control pain related to nerves.
Opioid pain medications
Opioids are used to help manage strong to severe pain. People experiencing strong pain may be given weak opioids like tramadol or codeine while more severe pain is addressed using strong opioids like oxycodone or morphine.
A common and understandable concern when it comes to taking opioids is tolerance, addiction, and overdose. Healthcare providers or pain management specialists may switch up a patient’s pain relief plan by using different types of opioids and ways of administering the medication and changing your dosage.
There are many ways that opioids can be administered:
- An adhesive patch that releases the medication over time.
- Patient-controlled analgesia allows the patient to control pain relief through a medicine pump that is attached to an IV.
- Provider controlled IV.
- Oral medications that are taken as a liquid or pill.
- Injections that are typically given into the muscle or under the skin.
- Medication administered directly to the spinal cord. This is usually for pain that’s difficult to manage.
Opioid misuse is not a topic to brush over, and we at Eirene acknowledge that. For many people receiving end-of-life care, it is essential for their daily comfort.
Surgery
Surgery is not commonly recommended during end-of-life care for pain management, but it may be helpful in some situations. People who for instance have a broken bone that requires surgical intervention may undergo a procedure because it will help provide pain relief during hospice care.
Non-pharmacological pain management
Pharmaceuticals are not the only option when it comes to pain management during palliative care. An integrated pain management plan most likely also includes non-pharmacological tools.
Some non-pharmacological pain management options include:
- Massage therapy
- Music therapy
- Acupuncture
- Meditation and mindfulness practices
Emotional Health and Pain Management
Another huge component of pain management during end-of-life care is mental and emotional health. Anxiety and depression can exacerbate pain and interfere with someone’s quality of life while dying.
Providers may recommend antidepressants or anti-anxiety medications as part of someone's treatment plan. It can also be incredibly helpful to work with a mental health provider or someone who can provide non-medical support like a death doula.
Pain Management During End-of-Life Care
Everyone has a right to live and die on their own terms, and with as much dignity and comfort as possible. Just like everyone has their own unique life, they also have a unique death. While that doesn’t include pain for everyone, it is the reality for many people.
Knowing your pain management options allows you or your loved one to navigate hospice or palliative care feeling informed and as prepared as possible. If you or a loved one are navigating end-of-life care know that our hearts are with you, and know you deserve all the support you can get.
Resources:
- World Health Organization. WHO Analgesic Ladder.
- Clinical Medicine Journal. Updates in palliative care – overview and recent advancements in the pharmacological management of cancer pain.
- National Library of Medicine. Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review.
