Pain Management

Clinical studies have concluded that more than 75% of cancer patients experience pain during the course of their illness, most having three or more different pains. Studies also show that nearly 80% of AIDS patients experience one or more pains in the late stage of the disease. Other disease processes have similar numbers.

90% of the pain can be treated with relatively easy methods of pain control.

Hospice philosophy emphasizes that relief of physical pain requires treatment of the patient's total pain (physical, psychological, social, spiritual, financial.)

What are the Hospice Care Concepts of Analgesics?

Keep it simple. Prevent side effects. Reassess frequently. There is no optimal opioid dose. There is no one maximal opioid dose. When using a sustained release opioid, also include an immediate release opioid. Addiction and tolerance are not clinical problems in patients with end stage diseases. Terminal pain requires around the clock opioid therapy.

What are the three groups of analgesics?

The three types of analgesics are Non-Opioids, Opioids, and Adjuvant Analgesics.

Non-Opioids:

Used for Mild to Moderate Pain
Work on Peripheral Nerve Endings at the Injury Site
Have Ceiling Effects

Opioids:

Work at Central Nervous System Level
Physical Dependence and Tolerance May Develop
No Pain Ceiling

Adjuvant Analgesics:

Antidepressants (Tricyclic) are used for Neuropathic Pains, Depression, Insomnia
Steroids are used for Acute Nerve Compression, Visceral Distention, Increased Intracranial Pressure, Soft-tissue Infiltration, Anorexia, Lymphedema, Bone Pain
Anticonvulsant Drugs are used for Neuropathic Pains, Myoclonic Jerks, Lancinating Pains, Tics

Fears that Contribute to Undertreatment:

Addiction	Withdrawal
Tolerance	Respiratory Depression

Escape Reality (Addiction) vs. Face Reality (Hospice Patients)