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 Pain and Symptom Management
Pain may be a problem with progressing illness, but it can be controlled to permit quality living. The goal of this section is to share with you some basic principles of pain control in order to apply them to your own situation.
Pain is personal. It is an intensely unpleasant feeling that only the person experiencing it can know. The causes of pain include bodily change from the physical effect of disease, pressure on sensitive structures, swelling from inflammation, and irritation produced by chemicals. Pain almost always causes anxiety or fear at first. When it
lasts for a long time, many people become depressed and have sleep difficulties. A vicious cycle, pain is accelerated by anxiety and tension, depression and sleeplessness. A comprehensive plan for pain relief always includes methods to relieve emotional distress and promote relaxation in addition to medication. You will see that hospice care incorporates both.
→ When pain is constant, a patient needs medication around the clock at regular intervals, even if it means waking him/her. This keeps enough medication in the blood at all times so that pain is always controlled. If the person waits until the pain comes back before taking the medication, he/she will need a larger dose
to quiet the pain. Just as the diabetic does not wait for signs of coma before taking insulin, so the hospice patient does not wait for pain to take medication to control it. In both situations, the purpose is prevention of symptoms by keeping a constant level of medication active in the blood. Some medicines last longer than others.
→ It is preferred that hospice patients take only a few different medications for pain. When a patient is on multiple pain control medications, there can be interactions and side effects and it is difficult to achieve balance on all when you change the dosage on one. A single drug, often a narcotic, raised to a level that controls pain yet does not cloud the mind usually is most effective. The preferred way
of giving medications is by mouth, but that is not always possible for a hospice patient. There are other mechanisms other than injection for administering pain medications if oral medication is no longer possible.
→ The amount of pain medication needs to be carefully adjusted and patiently readjusted in order to prevent suffering. If, after symptoms appear to be controlled, you notice pain, discomfort, or side effects that are new or unusual, be sure to let the hospice staff know.
→ The Hospice Nurse will monitor medications and use, but if you have concerns about running short, especially on a weekend or holiday, be sure to let your Hospice Nurse know.

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