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Pain management during hospice care

Mahveen Hussain | posted May 29, 2012 | Bookmark and Share

One of the greatest fears many people have is dying in pain. Those of us who work in hospice understand this fear and make pain management a top priority. In fact, people who choose hospice care are far more likely to get adequate pain relief and die peacefully than those who do not.

There are several reasons for this. First, the focus of hospice care is on pain and symptom management. It’s at the heart of what we do.

Second, federal guidelines regulating hospice care require that we make a concerted effort to control patient pain. This is reflected in most state laws, too.

Another reason is the interdisciplinary team approach employed by hospice. Patients may have an attending physician, specialists, social workers, nutritionists, nurses, pharmacists, occupational therapists, speech therapists, a spiritual leader and volunteers who are working with them at any one time. By taking a team approach, the quality of life for both the patient and the family may be better improved.


Many pain treatment regimens begin with over-the-counter medications. Severe pain, however, often calls for narcotic pain relief. It is important to note that different types of pain call for different kinds of medication. Bone pain, for example, might require something different for pain management than a muscle spasm. A hospice doctor or specialist is trained to know the subtleties of pain and prescribe appropriately and adequately.

In the past, I’ve heard some concern about creating “addicts” with narcotic pain therapy. Understandably, people don’t want to “use drugs,” but they mistake legitimate medical care for illegal drug-seeking behavior. Proper pain relief for the terminally ill is entirely appropriate and I’ve never seen a problem with addiction created in this population.

There are other types of pain relief available, as well: non-steroidal, anti-inflammatory drugs, corticosteroids, tricyclic antidepressants and anticonvulsants are included in the arsenal of a trained hospice doctor.

Other approaches

The atmosphere surrounding a terminally ill patient is crucial — they should be shielded from tension and stress. If a patient prefers quiet, by all means, let them have quiet. Perhaps patients would like relaxing music or being with their family members. Some patients want to be held. Others do not. The key is to take into consideration the wishes of the patient and make every effort to accommodate them by providing a supportive atmosphere.

Part of the team of professionals in hospice could include a music or art therapist, someone to work with the patient and help sooth them. Massage therapy might also be appropriate for pain relief and relaxation.

There are other types of pain than physical, like emotional and spiritual pain. For a person in pain over difficult family relationships, the social worker might step in and offer assistance. Spiritual concerns might be addressed in visits with a chaplain or rabbi.

The value of pain management in hospice care

Hospice is about patient advocacy and a hospice team works with the patient to improve and maintain physical and emotional comfort. Team members provide instruction on assessing pain and dealing with it, no matter the form in which it appears. For the terminally ill, hospice care can make their last days comfortable and meaningful, a gift for both the patient and the family.


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