Hospice care centers can be comforting and relaxing homes for those who can no longer care for themselves. However, many people may be unclear about what pain management therapies can be provided to their loved ones in hospice care. Pain management is one of the primary responsibilities of a long-term care facility, as many of the patients living at the centers are elderly and have numerous health concerns.
Signs Someone is Experiencing Pain
Some hospice care individuals may feel ashamed or embarrassed to admit physical pain or avoid mentioning pain around loved ones to prevent further concerns. Other patients living with mental disorders may have a difficult time communicating their pain to others. This makes it challenging for nurses to determine when a patient needs assistance or pain management therapies. The most common signs of someone experiencing pain are:
- Eyes shut tight or blinking quickly
- Sharp inhalation or fast breaths
- Holding a rigid posture
- A rise in blood pressure
- Fidgety behavior, such as rocking back and forth or pacing
- Crying, yelling, or moaning
- Refusing care when offered, especially for a particular area of the body
- Increased confusion
- Growing more aggressive or withdrawn
Individuals may exhibit one or multiple of the above signs, and some may attempt to hide these indications. Pain may also not be physical, as emotional or mental pain are common in hospice care patients. Nurses and caregivers should be careful to consider the above signs as only some of the potential indications a patient is feeling pain in some form. However, pain may manifest in other ways.
Before any medications or therapies are prescribed, hospice care staff will evaluate a patient’s pain. This is done level using a scale system, including a numerical scale, a range of emotional faces shown crying and smiling, or the FLACC scale.
This scale (Face, Legs, Activity, Cry, Consolability) is commonly used on young children who are unable to describe their pain in addition to adults that may also have difficulty communicating. Each of the five categories is given a 0 – 2 rating based on the patient’s appearance and actions. The higher the overall rating, the more pain the individual is in.
Types of Pain Management
Pain management doesn’t necessarily mean medications. Over years of study, researchers have found that pain can be managed through medications in addition to various therapies. Despite this, a combination of pain management treatments may be needed for individuals based on his or her needs. This should be discussed with a physician or professional whenever possible. Caregivers may be responsible for the patient, but additional treatments may satisfy patients’ needs.
Medicinal or Pharmacological
This is the most common method for pain management, but it’s also one that many patients’ loved ones show the most concern for, given the number of centers that use opioids. Because of this concern, hospice care staff are very careful in the amount of medication provided to patients and frequently assess various factors, such as whether the medication is needed in a lower dose or at all and whether the patient may be hiding or throwing pills away.
Common opioid medications for hospice care patients include morphine, oxycodone, methadone, and hydromorphone. These are given in extremely low doses to avoid addiction and overdosing, but the dose may increase if recommended by a physician. That’s not to say opioids are the only medications provided to patients. Many individuals receive acetaminophen or versions of dexamethasone for pain, lorazepam or haloperidol for anxiety, and even oxygen for those feeling short of breath.
Not all patients wish to receive medications and, depending on the pain’s location and intensity, light physical therapy may be another source of pain management. Physical therapy may help reduce pain and increase mobility in various body areas through stretches and strength-building exercises. Because of many patients’ limitations in hospice care, simple arm raises, leg stretches, and walks may be the extent of physical therapy offered in hospice care.
If physical therapy isn’t the best choice for the individual’s pain management, therapeutic massages may be another non-medical treatment. During this treatment, a massage therapist gently massages the body to relieve physical, mental, and emotional pain and stressors. Massages can also lower blood pressure and heart rate, making the patient feel relaxed and comfortable.
Mental and Spiritual
Not all pain is physical. Many patients in hospice care may experience mental or spiritual pain, such as depression or anxiety. Hospice care centers offer pain management through conversations and active listening with psychologists, social workers, or chaplains. Depending on the pain the patient is experiencing, hospice staff may encourage counseling as well.
If the patient continues to experience high levels of anxiety or depression, an anti-anxiety or depression medication may be prescribed to support whatever counseling the patient is currently attending.
Additional Pain Therapies
In addition to the pain management treatments discussed above, hospice care centers may also offer alternative therapies to their patients. These may include music, pet, or aromatherapy.
Music therapy may include singing songs and creating music and has shown to be a great pain management source for mental, emotional, and spiritual pain.
Pet therapy provides patients with a trained therapy dog or another animal that patients can pet and interact with. Petting dogs have been proven to release positive hormones, making the patient feel less lonely and encouraging conversation.
Aromatherapy assists in various areas of pain management, including reducing:
- Digestion issues
- Muscle spasms
Lavender and orange oils are commonly used in hospice care centers.
Pain management is a large part of hospice care, but that doesn’t mean there’s only one approach available. Many care centers offer pain management treatments other than medications, though the physician may occasionally require medications. If you or someone you know is preparing to enter hospice care and has lingering concerns, feel free to give us a call. We want to help you feel at ease with your hospice care and the treatments offered there.