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Hear this textPain Management
Pain Management in Palliative Care
The overall philosophy of palliative care is focused on alleviation of suffering from physical, psychological and spiritual pain and other symptoms and the care of patients with a life-limiting illness. When people think of terminal illnesses, they often imagine some degree of pain and suffering. Many people are afraid of both living and dying in pain. Fortunately, there are health care professionals who specialize in managing pain. These include palliative care medical professionals, who specialize in managing pain and other symptoms related to serious, often life-limiting illness, and pain specialists, who focus on treating pain from a wider range of disorders and medical issues. Patients living in Western Pennsylvania are fortunate to have a variety of pain management expertise in the form of hospice and palliative care clinicians and services and pain specialists in their own back yard.
There are many misconceptions about pain management even in the context of hospice and palliative care services. As substance abuse issues have increased, the general public and even some clinicians have become increasingly wary of managing pain with prescription pain medications. In fact, a relatively small number of patients with terminal or life-limiting illnesses will ever experience the addiction and abuse problems that people who have true substance abuse problems face. When prescribed by a caring and knowledgeable clinician, pain medications can greatly improve a patient’s overall quality of life. Effectively treating pain is an essential component of quality care. It is not “giving up” or euthanasia.
In addition to traditional narcotic pain medications, there are a range of pain management options and alternative therapies. Anti-inflammatory, seizure medications, steroids, antidepressants, and other classes of drugs are used to relieve different types of pain. Alternative and holistic therapies are increasingly popular complements to traditional pain control methods. These therapies include hypnosis, guided imagery, massage, Reiki therapy, and acupuncture. They can all be used in addition to prescription medications. Locally, there are hospital-based programs that focus on alternative therapies as well as private practitioners and centers.
Pain management often starts with the patient’s primary care physician, oncologist, neurologist, cardiologist, or another specialist. In cases where pain management becomes more complex, these physicians often seek assistance from palliative care specialists, or even pain management physicians. Physicians who specialize in pain management utilize interventional pain therapies. These methods consist of local joint injections, nerve blocks, surgical procedures, epidural catheters, and various other methods. There are a number of pain specialists in Western Pennsylvania. Most are in partnership with university and other private institutions on an inpatient and outpatient basis.
Depending on where a patient receives his or her care, there are many trained clinicians who can follow patients for pain and symptom management. Most of the major hospital systems now have inpatient and outpatient palliative care services. If you are in need of pain or palliative care services while in the hospital, ask your physician for a consultation with the palliative care team. There are also various outpatient disease-based palliative clinics in the community such as heart failure, cancer, liver disease, HIV, and women’s health. Finally, a number of home hospice and palliative home care services exist throughout our region. Home palliative services can serve patients who are still receiving active treatment or who are not ready for hospice. Home hospice typically serves terminally ill patients for whom disease-based treatments are no longer working and who wish to focus their care at home. Many programs have both hospice and palliative care components. Nurses who are specially trained in pain and symptom management are available for home visitation and symptom management, and often complementary therapies are available that can help with pain and symptom management.
Justin Engleka, Hospice and Palliative Manager, Allegheny General Hospital
