Pain Management in Hospice Care

The number of Americans using hospice and palliative care is growing; in 2012, about 1.5 million chose to enter hospice. One of the many questions patients and their families have about beginning this form of care is pain management. For some, they may perceive hospice as stopping all medications. That’s not the case, according to Scott Vouri, Pharm.D., BCPS, CGP, assistant professor of pharmacy practice at St. Louis College of Pharmacy. Dr. Vouri was recently asked by the Erickson Tribune to talk about pain management while in hospice.

Many older adults are scared to use opioids for pain control for day-to-day pain and for hospice because they want to remain alert and able to function. Opioids are a classification of medicine which are known for being effective in pain management, but also have serious side effects, including sedation, feelings of euphoria, and constipation.

Not all hospice patients experience pain; in those that do, there are a variety of pain regimens that can be tried first prior to using more powerful options like opioids. These include acetaminophen like Tylenol,  or ibuprofen, like Advil, which do not cause sedation and drowsiness. If these do not control the pain, it may be appropriate to use opioids. These medications come in a variety of potencies and do not all act the same. Just like all other medications in older adults, it is recommended to start low and go slow; this is the same with opioid pain medications.

If you start low, these medications can then be slowly increased over the course of days to make sure the patient does not become oversedated. If at any time the patient feels he or she is too sedated and the pain is at an appropriate level, then the medication dose can be reduced. If high doses of medication are used or if they are increased too rapidly, it can result in oversedation, which could be very harmful to the patient.

I’ve talked with many patients and families who are concerned about addiction when taking opioids. I tell them addiction and tolerance can be confused. Addiction is a chemical dependence to the medication, whereas tolerance is the body’s response to the dose of a medication and requires higher doses of the medication to have the same effect on pain. With tolerance, a higher dose of medication is purely for pain relief and not for dependence.

The complete article can be found here.

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