Neuropathic pain arises from damage or dysfunction of the nerves. It can be caused by conditions such as cancer, diabetes, or nerve compression. Neuropathic pain is often described as shooting, burning, tingling, or electric-like sensations. Any pain related to the nerves can be tricky to deal with. But, medical professionals try to diagnose the root issue and provide relief from the nerve pain as much as possible.
Physical pain is a common kind of pain that every hospice patient has to deal with. Most kinds of terminal diseases have physical pain as a side effect. Hospice patients can experience musculoskeletal pain due to conditions like arthritis and fractures. This results in chronic pain. Alternatively, they can also experience bone pain or limb pain. Bone pain can occur due to cancer that has spread to the bones or other bone-related conditions. It is often described as deep, aching, or throbbing and may worsen with movement or weight-bearing. Regardless of what kind of pain the patient may experience, the idea is to alleviate it as much as possible.
Hospice patients may also experience psychological and emotional pain. It may be related to anxiety, depression, grief, or existential concerns. These forms of pain are important to address alongside physical pain to provide holistic care and support. Any patient who is nearing death will need someone to help them to get through it emotionally. Any kind of disease puts a toll on our minds and dealing with a terminal disease can be even more challenging. However, doctors and nurses at hospice institutions try to comfort the patients and their families. They stay by their side until the end, helping them to cross the threshold of life.
The method of how pain is managed in hospice stays pretty much the same for all hospices. Let us go through them one by one.
Assessment
Before the pain can be managed, it has to be properly identified. Healthcare professionals assess the patient’s pain by evaluating its intensity, location, and duration. They use various pain assessment scales and tools to obtain a clear understanding of the patient’s pain experience. Once the assessment of the pain is done, the health professionals can go on to address the pain and reduce it.
Individualized Treatment Plan
Hospice care has different kinds of patients with different types of pain. Naturally, one overall treatment plan is not going to work every single patient. As a result, every patient needs to have a personal treatment plan that is going to specifically address the kind of pain they are suffering from. For instance, the treatment plan for an elderly patient and a young patient is definitely not going to be the same. Based on the pain assessment, a personalized treatment plan is developed by the hospice team. The plan may include a combination of pharmacological (medication-based) and non-pharmacological interventions. The plan ensures that an adequate pain management procedure is carried out.
Medications
Pain medication is often an essential component of pain management in hospice care. Doctors prescribe appropriate pain-relieving medications in the most effective dosage and administration method. The dosages are carefully adjusted based on the patient’s response and pain levels.
Non-Pharmacological Interventions
A wide range of non-pharmacological interventions are also used. These can include physical therapy, massage therapy, and music or art therapy, among others. These approaches aim to enhance comfort, reduce anxiety, and promote a sense of well-being. Hospice care institutions understand that pain is not always something physical. And even if it is solely physical, medications may not be the only answer. Especially in their last moments, patients are just looking for any method that can help them have a happy few last days. There are barriers to pain management too, but a hospice team tries to provide comfort as much as possible.
What medications for pain in hospice?
Different medications for pain in hospice are used for pain treatments. Analgesics among patients is common in a hospice setting and it is even more common for geriatric patients. Depending on the pain scales, medical professionals prescribe suitable medications. The dosage differs from patient to patient. Adjuvant analgesics and palliative medicine are used.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs like ibuprofen, naproxen, or diclofenac are often used for mild to moderate pain. They are used for reducing inflammation. They can be effective for pain caused by musculoskeletal conditions or certain types of cancer pain.
Opioid Analgesics
Opioid drugs are powerful pain-relieving medications. They are often the mainstay for moderate to severe pain in hospice care. Examples include morphine, oxycodone, hydromorphone, and fentanyl. These medications work by binding to opioid receptors in the body, reducing pain perception. Opioid therapies can be administered orally, through injections, patches, or subcutaneous infusion pumps. However, the administration of opioids must be done carefully. Potential side effects or adverse effects must be kept in mind.
Strong Opioids
Strong opioids are usually given to patients who are suffering from severe pain. Cancer patients or other terminally ill patients are administered strong opioid medications occasionally. Weak opioids may not work in such scenarios. However, long-term use of opioids is not usually recommended by doctors. This is especially for the management of cancer pain, due to substance use disorder.
Are there individualized pain management plans in hospice?
Yes, there are individualized pain management plans in hospice. They are the gold standard of any hospice care. A hospice care team recognizes that each patient’s experience of pain is unique, and their pain management needs may vary. Therefore, a personalized approach is essential to ensure optimal pain relief and comfort. A single pain management plan is not going to work for every patient. Therefore, healthcare providers and hospice nurses take out the time to assess each patient separately. And, assign plans that are going to be specific to them. This characteristic of hospice care essentially distinguishes it from a regular hospital.
Is there therapies for pain in hospice?
Yes, there are therapies for pain in hospice. While medications are a big part of the pain management plan in hospices, other forms of therapies are also used. Physical therapy is the most common example of therapy offered for pain management. It focuses on improving physical function, mobility, and strength. Therapists work with patients to develop tailored exercises for effective pain management. However, apart from physical therapy, other forms of therapy are recommended too. Some examples include music therapy, art therapy, heat and cold therapy, and so on. Radiation therapy is also recommended. Complementary therapies help hospice patients to do mentally well too.
Pain management vs Palliative care
Pain management vs Palliative care is often considered the same but they are not. Pain management is focused solely on identifying the cause of the pain. And, consequently recommending methods or medications to address the same. However, palliative care is more of a comprehensive approach. It aims to provide holistic care to individuals with serious illnesses, regardless of the prognosis. Palliative care teams focus more on the overall well-being of the patients rather than the acute pain-causing disease. For pain management plans, the treatment of pain is a common concern. But, palliative care takes everything into consideration, not just the pain.
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