One of the first questions often asked after hearing the diagnosis of a life-limiting and progressive illness is, “Will I suffer?”  This question automatically produces fear and anxiety.  Pain control with improved quality of life is a primary goal for the patient, the caregiver and the hospice team.
Each person views pain differently.  Some feel pain is inevitable and something they must bear.  Others are afraid to admit that the pain is increasing as a sign of rapid progression of the disease.  Some are fearful of addiction to medication.

It is important to recognize and talk about how pain is experienced and expressed.

Is the pain restricting movement?

Is the pain resulting in shallow, restricted breathing?

Is the pain causing depression and withdrawal?

Is the pain expressed as tension or irritability?

Is the face tight, with the brow furrowed?


Pain Medication

Bright-Horizon-Hospice-PainAddiction should not be considered in pain management of the patient with life-limiting and progressive illness. Addiction occurs when narcotics are used for psychological and emotional reasons.  Your physician and primary nurse will be glad to discuss any questions you have regarding use of narcotics.

Side effects may occur with the use of any medication. These may include dry mouth, increased heart rate, constipation, drowsiness, nausea and vomiting. Report all side effects to your primary nurse.

Giving pain medicine:

  • If nausea has been a problem, offer prescribed nausea medication with a little water 1/2 to 1 hour before pain medicine.
  • Roll the head of the bed up or position the patient with pillows.
  • Moisten the mouth before offering the medication.

Bright Horizon Hospice Services suggestions for management of side effects may include:

  • Dry mouth: Frequent fluids, hard candy or gum, use of artificial saliva.
  • Increased heart rate: May decrease within a few days of starting medication or changing dosages.
  • Constipation: Watch for increased constipation with increase in pain medication.
  • Drowsiness: Usually subsides within 1-3 days of starting or increasing dosage of medication.
  • Nausea and vomiting: Note if this occurs with each dosage.  Notify the nurse, and a change in medication will be discussed with your physician.

Non-narcotic pain relievers such as Ibuprofen or antidepressants may be ordered for “bone pain” or “nerve pain.”  These are to be used with other pain medication to decrease specific symptoms of the disease process.  Their effect is not immediate and may be seen as ineffective.  These medications are to be taken regularly for the desired effect.

Narcotics are most effective if taken on a regular schedule.  A long-acting medication is usually ordered to avoid the “up and down” response to pain.  Waiting until the pain is “bad enough” before taking the medication is an ineffective approach to controlling pain.

A second, more rapid-acting medication may be ordered for breakthrough pain (sudden or occasional pain, unrelieved by the long-acting medication).  Keeping a record of how often the rapid-acting medication is needed will alert the physician and nurse to re-evaluate the need to increase the long-acting medication.  Sudden, severe pain may occur and be frightening for both the patient and the caregiver.  This may occur late in the evening or at night.  Give the ordered amount of medication for breakthrough pain.  If unrelieved after 45 to 60 minutes, call the hospice nurse.  The nurse can make suggestions for added pain control and comfort measures.

Remember, patients who have lived with pain may not show the same signs of pain or complain the same way as someone who is suddenly experiencing pain.  Watch for:

  • Decreased activity and movement • Furrowed brow and tight facial muscles
  • Short, rapid breathing • Resistance to being turned or
  • Stiffness or tenseness of the body re-positioned

NOTE: The above signs may also be observed during sleep or if the patient is in a coma.

Your physician may order medication for anxiety or restlessness.  These medications may be given in combination with pain medication to offer a more rapid response to pain relief.  The hospice nurse will review the medication and advise you in administering these medications in times of uncontrolled pain.

Relaxation, Breathing and Imagery Exercises

Pain causes the body to tense, and in turn the body may experience increased pain.  Breathing may become shallow and rapid.  Often patients find relaxation breathing helpful, especially with a sudden increase in pain and awaiting relief after taking pain medication.  It may be helpful for another person to read the exercises to the patient.  You may want to ask your nurse or social worker to help with these exercises.

Close your eyes and take a long, slow, deep breath.  You may wish to sigh as you breathe out. Concentrate on breathing slowly and deeply for several seconds.  Mentally repeat a phrase with each breath such as (breathe in) “I am” (breathe out) “relaxing.” (Breathe in) “My pain” (breathe out) “is decreasing.”  Or, if you find comfort in your faith (breathe in) “God is” (breathe out) “love.” Continue to concentrate on the breath and feel your body relax and sinking into a chair or bed. Stop the exercise at any point by slowly telling yourself, “It is time to open my eyes.” Slowly open your eyes.

Close your eyes and breathe in a long, slow breath.  Feel the air moving into your lungs.  As you breathe out, feel the air move to the point of pain and exit at that point as if the breath is moving the pain out of the body.  Continue the exercise as long as needed to feel the relaxation of the area of pain.  End the exercise by telling yourself it is time to open your eyes and slowly do so.

Close your eyes and breathe deeply and slowly.  Imagine an object you consider beautiful: a rose, a tree, a mountain or stream.  Picture the object far away and bring it closer until you can see very small details such as the petals, the branches, and leaves, or the smell of the earth or the feel of water.  Continue to breathe slowly and deeply.  Surround yourself with the beautiful object.  If your mind goes back to the pain, it is OK, just focus again on the object and breathe slowly and deeply.  End the exercise by telling yourself it is time to leave the object and slowly open your eyes.

Close your eyes and breathe deeply and slowly.  Imagine yourself walking under large trees.  The air is clear and fresh.  Breathe in the air.  You walk to a clearing and you look around to see a beautiful place.  Imagine whatever is beautiful to you: your backyard, the beach, a mountaintop. See the color of the sky or imagine animals, plants, water, or the air that surrounds you.  You are there and filled with love and peace.  Breathe slowly and deeply.  Enjoy every detail of the special place and know you can visit as long as you want.  End the exercise by telling yourself it is time to leave and slowly leave and open your eyes.

Heat And Cold

Heat and cold applications, such as heating pads and ice packs, may be used for 15-30 minutes over the areas of pain.  Always use a cotton cloth between the source of heat or cold and the skin. Check the skin frequently.  Avoid use of the highest setting on heating pads or use of heating pads during sleep.


General Comfort

Comfort may also be increased by:

  • Changing the body position.  Don’t sit or lie in one position for more than two hours.
  • Use pillows under arms, feet and legs.
  • Provide a pleasant view of a plant, flowers, or favorite things.  Open curtains or blinds for added light.
  • Also provide clean fresh sheets, a tidy room and a calendar and clock to keep track of the day and time.
  • Wash face and hands throughout the day.
  • Apply lotions to soothe the skin.
  • Share a loving touch.