4 Things to Know About Pain Management During End-of-Life Care

When Brittany Maynard moved to Oregon so she could undergo assisted-suicide under Oregon's Death with Dignity Act, she made national headlines. The 29-year-old was diagnosed with a brain tumor last spring and was told she only had six months to live. She ultimately decided to end her life on Saturday, Nov. 1.

Manish Srivastava MD, a hospice and palliative medicine specialist, says many people – especially the friends and family of someone who has a terminal illness – often wonder: When do people want to end their life?

"It's when they have this fear that they'll be suffering," Dr. Srivastava MD, explains. "But, if you look at statistics from Oregon, where it is legal, they say that many people ask for it, but not many people take that course because their symptoms can be well controlled."

#1: How Does Pain Control during End-of-Life Care Work?

Your care team typically asks you to rate your pain on a scale from 0 to 10. Then, through medical – and sometimes spiritual – intervention, your team works with you to develop an action plan, based on your individual goals, which could range anywhere from getting a good night's sleep to exercising without pain.

In some cases, pain medicine is given on an as-needed basis, but in other cases, if you're experiencing pain all the time,then your doctor may prescribe a scheduled dose of long-acting pain medication or routine doses of short-acting medication in order to better control the pain

#2: Will I Become Addicted to Pain Medications?

"Older patients are very worried about addiction," Dr. Srivastava points out. "I tell them I'm not worried about addiction. My goal is to control your pain and get you down to a pain level where you're comfortable. As long as you are taking medications as prescribed, there is not a concern about addiction. I give them example of hypertension – just like you have to take medications to control high blood pressure, in a similar way, you have to take medications to keep your pain controlled.

Initially, depending on your illness, you may start off by taking over-the-counter pain medications, including Tylenol or Motrin, and if those aren't effective you may be prescribed stronger medications, like Morphine or Oxycontin.

For the pain associated with certain types of cancers – pancreatic and pelvic cancers, for example – nerve-numbing substances, called nerve blocks, may be prescribed.

#3: How Does my Mental State Affect Pain Levels?

Your emotional or mental state can play a significant role in how well your pain is controlled, too. If you're taking heavy doses of Morphine, for example, your pain shows little to no improvement, this usually tips your doctor off that you may be having feelings of anxiety or guilt, Dr. Srivastava explains.

In this case, your doctor may bring a social worker or psychologist into the care team to help you resolve the issue. If your doctor senses spiritual distress, he or she may suggest having you meet with a chaplain. "Is there anything they're seeking forgiveness for? Is it something where they've done something they don't feel is right that they are just not able to get over? Sometimes, having somebody sit down and talk to them and resolving that conflict helps with pain," he adds.

#4: How Can I Manage Pain without Medication?

Another option that doesn't involve medication would be relaxation techniques like meditation, yoga or deep breathing exercises. These activities use your body energy to help alleviate stress and, in turn, manage pain.

Additionally, creative activities, like music or art therapy, can help divert your attention from the pain. "Pain is a perception," Dr. Srivastava says. "If you're able to divert your attention to something else that is more fun and joyful for you then you tend to concentrate less on your pain and more on the positive things in your life."

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