Managing pain

A common fear of both terminally ill individuals and their loved ones is that the individual will experience great suffering and pain. Many of us are more afraid of dying in pain than of death itself. Pain should be treated as seriously as the disease. Pain can significantly impair our quality of life, even causing us to give up on living.

Therefore, a plan to manage pain needs to be discussed along with the plan to manage the disease. In most cases, severe pain and physical discomfort can be managed through the effective use of pain management and palliative care (controlling the symptoms). To accomplish this, providers use

  • medications (narcotics and non-narcotics)
  • surgery and nerve blocks
  • relaxation therapies
  • biofeedback
  • massage
  • good nursing care

Many terminally ill patients experience a great deal of pain and suffering for the following reasons:

  • They are reluctant to tell others about their pain.
  • Their providers and family may not accept the severity of the patient’s reporting of the pain.
  • The providers may not consider pain as seriously as other aspects of the patient’s illness.
  • The providers may not be informed about the medications and other methods that can be effective and appropriate to reduce pain.
  • The fear that providing or taking narcotics will lead to addiction.
  • A lack of access to sufficient quantities of narcotics for patients who need very high doses of them.
  • The fear of causing death by providing aggressive pain management.

People with terminal illness may require extremely large doses of narcotics to control their pain. Despite the fact that clinical experience has shown that those who take narcotics for pain management rarely become psychologically addicted, myths about addiction can be a serious barrier to effective pain management. Fears of causing death are similarly misplaced.

Hospice care for individuals with a terminal illness is a team approach to providing for holistic care that is aggressive at managing pain. Asking your physician about the right time to start hospice can assist in good pain management and provide better quality of life at the end of life.

It is important to recognize that the disease is causing the death, not the medications and procedures used to control pain. Pain management is provided simply to keep the dying person comfortable.

How to ensure good pain management

  • Ask your healthcare providers how they will manage any pain that might result from your illness. Different types of illness might require different approaches. Your provider should have a plan to ensure you have access to appropriate pain specialists.
  • Consider what trade-offs you are willing to make for pain management. Some people would rather endure more pain if it meant they would be more alert.
  • Let your caregivers know when you are in pain. You have a right to expect your pain to be taken seriously.
  • Describe your pain as specifically as possible. Let your provider know
    • how it is affecting your ability to do specific things
    • when it is better or worse
    • where it falls on a scale of 1 to 10
  • When a pain management plan is implemented, follow the plan. The goal of good pain management is to prevent you from experiencing pain. Once you are in pain, it requires much more medication to bring the pain under control.