Diane Ronayne ©2005

Resources

Pain & Symptom Management

Management of pain and other symptoms related to end of life is vitally important in order to be free to engage in the final chapter of life. Relief includes the obvious condition of physical pain, but also emotional and/or spiritual pain.

Dealing with the wide array of symptoms that may be present near the end of life can sap the energy needed to complete life in the way we would like. If a person is dealing with pain or the discomfort of symptoms associated with approaching death, it is difficult to say "Please forgive me. I forgive you. Thank you. I love you." These four simple statements are a powerful tool for easing suffering as we are facing life's end - our own or a loved one - and preparing to say "Good-bye." The Four Things That Matter Most, Ira Byrok

This page highlights information about physical pain. A wide variety of information on symptom management is included in the list of resources.

Cause & Importance of Treating Pain

Many serious diseases, such as cancer and AIDS, cause pain. Pain can be intermittent or constant, and can vary in severity from mild to severe. It can have many different qualities, such as burning, shooting, aching, piercing or pinching. Many factors influence the perception of pain, including mood, activity level, stress, and the availability of pain-relieving therapies. Pain can be caused by:

• The activation of pain receptors by something that injures pain-sensitive tissues (nociceptive pain). Tissue damage from a mass (like a tumor) or from inflammation, for example, can cause this type of pain.

• Nerve damage (neuropathic pain) from a virus, chemotherapy, trauma or a disease such as multiple sclerosis.

Treating pain is important. Unrelieved pain can cause patients to:

• Experience depression

• Experience disruptions in activity, appetite and sleep

• Feel helpless and anxious

• Give up hope

• Reject treatment programs

• Stop participating in life to the fullest extent possible.

Excerpt taken from Net of Care

Emotional or Spiritual Pain can produce physical pain. A comprehensive assessment by the physician and other health care providers is important when developing a plan to meet your loved one’s individualized care needs. Nurses, social workers, chaplains and physical and/or occupational therapists are health care providers that can participate in the assessment.

Pain Assessment

Location: anatomic location pain. Document on pain map, anatomical drawing or description tool.

Intensity or severity: how severe? Document by numerical, verbal descriptor or faces scale.

Frequency: The number of occurrences in a specified period of time (i.e., 24 hours).

Quality: Description of type of pain. Document symptoms such as: aching, annoying, cramping, exhausting, nauseating, pounding, sharp, throbbing, stabbing, agonizing, blowing, dull, fearful, nagging, penetrating, quivering, shooting, suffocating, numbness, tingling, weakness, spasm, burning, gnawing, pressure, squeezing, radiating, stabbing, tingling, touch sensitive.

        Pain Behaviors – Facial (wrinkled forehead, tightly closed eyes, grimacing, frowning);

        nonverbal behavior (bracing, rubbing, guarding); vocalizations (crying, yelling, groaning,

        moaning).

        Nonverbal indicators of discomfort – Aggressive, crying, fearful, noisy respirations, pacing,

        repetitive, restless, rocking, confusion, irritability, increased activity, withdrawal, tense, calling

        out, grunting, knees pulled up, other – change in usual activities or behavior patterns/routine.

Duration: how long the pain has been present and continues to be present (lasting minutes or hours). Document if pain was sudden or a gradual onset, intermittent or continuous.

Pattern: how the pain starts, what was being done when it started, what makes it better, what makes it worse.

This Pain Assessment material was developed by the QIO program for CMS’ NHQI and is intended as general information. Any individual using the material must consider the possibility of human error, changes in medical sciences, and the need to use clinical judgment in each specific case.

Pain Management

Pain usually can be controlled. There are many treatment options. To offer the best approaches for pain, doctors must recognize that pain is different in every person. All patients who experience pain deserve a detailed evaluation of the pain, the effect of the pain, and the diseases that may be causing the pain.

Symptom Management

Symptoms at the end of life are different for each person, and one should not assume that people would have pain or any other particular symptom. While each person's need for symptom management is individual, what we all have in common is the right to expert symptom control and a reasonable quality of life. Control of symptoms is essential. To accomplish this, it's important to have symptoms managed by experts in pain and end-of-life care.

Pain and Symptom Management Resources

Send your favorite sites to Jill Darrington, A Better Way Coaltion.

If you find a dead site - let us know!

American Academy of Family Physicians, American Family Physician, Journal

• Challenges in Pain Management at the End of Life

• Management of Common Symptoms in Terminally Ill Patients: Part I.

          Fatigue, Anorexia, Cachexia, Nausea and Vomiting

• Management of Common Symptoms in Terminally Ill Patients: Part II.

          Constipation, Delirium and Dyspnea

Americans for Better Care of the Dying, Handbook for Mortals: Managing other symptoms.

Caring Connections

Net of Care, Symptom Management Information Anxiety - Appetite Loss - Confusion - Depression Difficulty Breathing - Dry Mouth - Fatigue - Gastrointestinal Symptoms - Pain - Skin Problems

Nursing Care at the End-of-Life, Good general information on pain and symptom management.

Partners in Care – Michigan University, Tools to provide help and guidance to patients and their caregivers.