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Palliative care - managing pain

End of life - pain management; Hospice - pain management

What it is

Palliative care helps people with serious illnesses feel better. 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 doctor or nurse 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 doctor or nurse 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 carbamazepine

What to 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 doctor 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 nurse or doctor.

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

Some people who take narcotics to treat pain become addicted to them. If you are concerned about addiction, talk to your nurse or doctor.

When to call the doctor

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

References

Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin North Am. 2010;45:271-327.

Mercadente S. Challenging pain problems. In: Walsh D, Caraceni AT, Fainsinger R, et al., eds. Palliative Medicine. 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 253.

Update Date: 5/11/2014

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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