Managing Pain and Symptoms in Hospice Care

When someone has received a terminally ill diagnosis with little time left to live, the next step is to seek hospice care. Managing symptoms in end-of-life care is one of the primary goals of hospice healthcare professionals along with providing empathetic company. While not all patients experience pain during their journey, treating pain when present helps improve one’s quality of life. Pain management in hospice is treated on a case-by-case basis by physicians, nurses, and therapists.

Recognizing Symptoms of Pain

Many patients will be able to openly communicate their level of pain. Healthcare workers use a scale for patients with a rating from 0-10, with 0 being no pain and 10 being the worst pain ever felt. However, when patients are non-verbal or have trouble communicating their needs such as with Alzheimer's disease, there will usually be signs of the symptoms of pain. Some of these signs can include:

• Heavy breathing

• Increased heart rate

• Tightly closed eyes

• Crying

• Fidgeting or rocking

• Moaning and calling out

• Guarding certain areas of the body

• Rigid posture

• Aggressive actions

Pain Management Medications in Hospice

Opioids are common medications used in hospice pain management. These medications work by blocking pain receptors in the body and are essential for treating moderate to severe pain. As we learned with the opioid crisis, opioids come with risks and harms, especially when misused by others for whom it is not prescribed. Opioids are addictive, which is not a concern for those in the end stages of life, and should be kept in a guarded place where only caregivers and hospice professionals can administer them to the patient. When managing symptoms in end-of-life care, opioids and other pain medications can offer relief for a higher quality of life.

There are some misconceptions about the use of opioids in hospice pain management that it can cause a loved one to pass on prematurely. In truth, studies have shown that effective pain management in hospice with the use of opioids can help patients live longer. When pain is subdued and anxiety levels are lowered, the body is under less stress in the struggle to live.

Levels of Care in Hospice

Many patients will start hospice care at the routine level. Under routine care, patients receive help with daily hygiene, meal prep, light housework, and medications. Hospice nurses pay regular visits to the household to help with these tasks and support the main caregiver. Hospice care shifts are typically between 4-8 hours during the day.

Should the patient’s pain levels and symptoms become intense, continuous care may be needed. During continuous care, the patient is cared for by hospice professionals 24 hours a day. Continuous care honors the patient’s wishes to remain in their home while hospice nurses work to stabilize the patient.

If the patient experiences a medical crisis, they may need pain management in a hospice facility. This level of hospice is called in-patient care. During in-patient care, the patient will have full access to nurses, doctors, and all the diagnostic equipment and medications needed to assess their situation and attempt to relieve their pain. Nurses may use intravenous medications that need constant monitoring. Both continuous care and in-patient care are short-term levels with a goal of returning the patient to routine care.

Emotional Pain Management in Hospice

While the patient’s physical pain level is of the utmost importance, spiritual and emotional pain are also of high concern. Emotional pain and anxiety can increase the symptoms of physical pain. Hospice care provides both medicinal and non-medicinal options to help with the patient’s mental well-being. Medications like Valium and Ativan may be used to reduce anxiety and agitation. The patient’s hospice care team will have open communication with the patient’s regular physician to ensure their care plan is being properly carried out.

Patients and their family members will also have access to spiritual and bereavement counselors who will help them cope with the impending loss of a loved one. Family members can continue to receive counseling from hospice care for several years after the patient has passed. Spiritual counselors help patients come to terms with their current situation and find solace in where they’re going within the realm of their religion.

Don’t Delay Hospice Care

When managing symptoms in end-of-life care, your loved one will have access to a diverse team of professionals. Doctors, nurses, therapists, nutritionists, counselors, social workers, and others help form, deliver, and adapt your loved one’s care plan. The sooner the patient starts pain management in hospice, the sooner they can start enjoying a higher quality of life. Contact A & H Hospice today for a free consultation about hospice care in Southern California.