In the modern world, palliative care has become a major concern in global health. Every nation is committed to improving the quality of care at the end of life; hence more emphasis has focused on the integration of both the pharmacological and non-pharmacological treatment. Pain is a companion that is frequent in patients under palliative care and management. Pain is generally acknowledged as a complex experience with affective, sensory, and cognitive measurements. Thus, effective pain management at the end of life incorporates the model of overall pain. Before doctors recommend painkillers, an evaluation is necessary to define the ache (Multiprofessional end-of-life care, n.d.). Pain management is an essential component during the management of end –of –life. Doctors should, therefore, focus on the pain management and symptoms of end-of-life. They need to attend to the patients for changeable physical reasons and take care of personal well-being and spiritual discomfort.
Pain relievers will be most beneficial if doctors take care of all constituents of total pain. As a result, end of life care patients receives both pharmacologic and non-pharmacological treatment. Pain relief must continuously be among the top significances in the management of end-of-life-care patients. Emphasis on managing additional symptoms or the underlying illness in the event of meager diagnosis can imply that the patients will have to wait to get palliative care and benefit from a new pain administration approach (Goring, 2018). Effective pain management at the end of life involves both non-pharmacologic and pharmacologic treatment. The main aim of this paper is to summarize pain management during end-to –life by talking about pharmacological and non-pharmacological treatment.
There is a range of pain management selections accessible to patients, whether at home or in a nursing home, hospital, or hospice care. Medications remain significant, but they are but a single means in the pain managing resources (Macauley, 2018). Before any medication is prescribed to a patient, doctors should assess the patient to determine the essence of the pain. In most cases, physicians often prescribe opioids for pain management during the end of life. This is because opioids are viewed as effective and safe in treating patients with severe and moderate pains, since their side effects are effectively manageable. World Health Organization (2004) advocates for a three-line method to pain relief in individuals with a terminal disease like cancer. The primary management line is non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin (Macauley, 2018). If this is inadequate to manage the patient's discomfort, the subsequent stage is to recommend mild opioids such as codeine. The moment the pain turns out to be so rigorous that it cannot be managed by codeine, then doctors may prescribe opioids such as morphine that are considered to be effective in severe pains.
Morphine is generally recommended drug for the management and treatment of pain in people with terminal illnesses. These include cancer and neuropathic pain resulting from diabetes and new situations that upset the nerves (Macauley, 2018). Opioids such as morphine are considered to be an optimal choice for the effective treatment of severe pains during terminal illnesses due to their high efficiency in pain management and relief; this is because they relieve patients from both pain and anxiety and allow them to breathe better and live in more comfort. In most cases, many patients experience significant pain during the end of life, and many express the desire or the preference to die. Despite advances made in comprehending pain physiology and the available medications, patients with terminal illnesses like cancer still report under or untreated pain. Expert guidelines and Equianalgesic dosing tables are important in monitoring, initiating, and adjusting doses of parenteral and oral opioids in patients with a terminal illness. The use of scheduled long-acting opioids is also critical in pain management in patients with severe pains.
Additionally, the control of visceral pain management requires multiple combinations of drugs e.g., patients with neuropathic pain tend to respond well to adjuvant medical treatment like antidepressants and anticonvulsants. Occasionally, aggressive treatments for pain relief, like surgical treatment, radiation, local nerve blocks, and intra-spinal or epidural supply plans, are suitable and essential when simple procedures prove unsuccessful (Hallenbeck, 2003). All through management, doctors need to assess the "total pain syndrome" and then align management with the reasons for the pain as much as possible, improving mental, communal, and nonphysical managements and avoiding unsuitable pharmacologic administration of psychosocial distress (Macauley, 2018).
Palliative care patients tend to have a high symptom burden. Occasionally, this is categorized as minor, and for others, it remains rigorous, generating a foundation ground for misery to transpire (Hallenbeck, 2003). Non-pharmacologic pain treatment during the end of life comprises all the techniques used in the management of pain and does not involve drug therapies. These approaches utilize different methods that help in disrupting the patient's thoughts and help him/her to focus concentration on better management and reduction of pain. By the use of non- pharmacological treatment therapies, doctors, nurse specialists, and nurses provide patients with a range of treatments that can alleviate and get rid of signs prevalent in severe ailments like agony, unease, and dyspnea. Nevertheless, these medications are occasionally inadequate in tackling the entire symptom (Non-pharmacologic pain management, n.d).
Luckily, medications might be improved by non-pharmacological interventions that might yield an even enhanced reaction. One of the non-pharmacological interventions is massage. Studies have established that massage is a beneficial pain reliever and other indications for individuals with grave diseases (Hallenbeck, 2003). Non-pharmacologic treatment methods, which take into account physical and mental approaches to diminish pain, can be incorporated as a first-line method and as an addition in multimodality managing (Non-pharmacologic pain management, n.d). Non-pharmacologic treatment includes distraction i.e., use of music, psychological interventions such as (relaxation, visualization, meditation, etc.), physical modalities, massage, aromatherapy, biofeedback (e.g., electrical nerve stimulation, heat, and cold), breathing practices, ecological adjustment (like decreasing noise and light), etc.
During the end of life care, most patients can be in severe pain, and the main aim of the care providers and the physicians is to ensure the patient is comfortable in their end life stages. Although many patients may experience severe pains during the end of life, there exists a wide range of options to improve their quality of life. End-of-life care aims to get rid of patients and their relatives' anguish by the complete care valuation and management of bodily, psychosocial, and mystical symptoms experienced by the patient. Physicians need to determine the connections between physical pain and social relationships. Pain regularly be assessed to help doctors ascertain and determine the nature of pain. Pharmacological interventions such as opioids use are the first line to help the patient in pain relief. Non-pharmacological treatment is also essential to help the patient live the most comfortable life possible in the hospice. Effective pain management in end of life care patients requires non-pharmacologic and pharmacologic treatment. Based on the discussion, it is evident that opioids, more so the use of morphine, provide significant analgesic relief, particularly in patients with extreme pains.
Goring, T. N. (2018). End-of-life care/Pain management/Palliative. Handbook of Outpatient Medicine, 81-95. https://doi.org/10.1007/978-3-319-68379-9_4
Hallenbeck, J. L. (2003). Pain management. Hallenbeck, JL, Palliative care perspectives. New York, NY: Oxford University Press, Oxford, 36-74.
Macauley, R. C. (2018). Pain and symptom management at the end of life (DRAFT). Oxford Medicine Online. https://doi.org/10.1093/med/9780199313945.003.0007
Multiprofessional end-of-life care. (n.d.). Social work in end-of-life and palliative care, 155-178. https://doi.org/10.2307/j.ctt1t89d74.13
Non-pharmacologic pain management. (n.d.). Encyclopedia of Pain, 1442-1443. https://doi.org/10.1007/978-3-540-29805-2_2818
World Health Organization. (2004). Palliative care: Symptom management and end-of life care. Retrieved September, 27, 2007.
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