The basic facts about pain management.
By Dr. R. Sean Morrison
The bad news: Over 60 percent of people with serious or life-threatening illnesses experience pain. The good news: Most pain can be eliminated or relieved with relatively simple therapies.
Although there are often concerns about taking pain medication, here are some important points to remember:
- People who take medications for the treatment of pain do not become addicts.
- Medications will continue to ease pain even if the pain worsens, since adjustments can be made to keep patients comfortable.
- The vast majority of side effects from pain medication can be treated.
- Treating and conquering pain often allows patients to spend time with their families and friends, communicating worries, hopes, and fears.
Patients and doctors should pay close attention to the level and location of pain. Pain can be adequately relieved by taking simple oral medications in over 80 percent of cases. Opioids (medications like morphine) remain the most popular treatment for moderate to severe pain. It is important, however, to understand that opioids can cause side effects. The most common are constipation, nausea, sleepiness, and, occasionally, confusion. Luckily, most but not all will disappear after a week or less, and others can often be treated with relatively simple therapies such as laxatives for constipation and special anti-nausea drugs. All side effects should be reported to your doctor for observation and treatment. It is important for patients and families to know that some of the drowsiness experienced by patients when they first start taking pain medications may be due to fatigue associated with having been in pain. Relief from pain allows the patient to finally sleep. If a patient’s drowsiness continues after several days, however, the doctor should be notified.
Good pain control for very weak patients who are close to death might result in a marked loss of alertness and long periods of sleep. While the majority of patients can have their sleepiness treated by changing pain medication or taking an additional medication to combat drowsiness, some patients will not respond to these therapies. In these circumstances, sleep is often welcome. An open and frank discussion about the goals of treatment should be had with the patients, or with family members if the patient cannot speak.
Patients should be asked whether they prefer to be awake with pain or to be given a medication that will let them sleep. If the latter, pain medications and medications that cause sleep should be administered until the patient is sleeping comfortably. It is important to note that in this setting, pain medications will not hasten or cause death. Rather, they will permit the patient to die naturally and comfortably in peace and dignity.
Dr. R. Sean Morrison is an Assistant Professor in the Department of Geriatrics and Medicine and Director of Research of the Hertzberg Palliative Care Institute at New York City’s Mt. Sinai School of Medicine. Dr. Morrison has received numerous awards for his work in geriatric and end-of-life care. Dr. Morrison is a graduate of the University of Chicago Medical School, and has been with Mt. Sinai since 1993.
Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.