When a loved one is nearing the end of a terminal illness, helping them stay comfortable will be a big priority.

Hospice care includes a type of treatment known as palliative care. While the terms are often used interchangeably, palliative care includes treatments given to ease pain and other symptoms. These may include things like depression, anxiety, fatigue and shortness of breath. 

It’s important to speak with your loved one’s care team for recommendations on the best treatments for their particular symptoms. You’ll also want to familiarize yourself with basic principles of pain management and medications that may be helpful.

Pain management for hospice patients generally includes two main categories of medications: 

• Opioids to reduce pain systemically, throughout the patient’s body
• Adjuvant analgesics, which target specific types of pain such as that caused by inflammation

Opioid Medications

Opioids are only available with a prescription and are the most commonly prescribed treatments for moderate to severe pain. They are commonly used in end-of-life care settings. 

There are several different methods for administering opioids: 

• Oral medications in pill or liquid form
• Injections
• Intravenous delivery
• Adhesive patches applied to the skin
• Medicine pumps
• Spinal injections

Opioids can cause a number of side effects. Ask your loved one’s care team about options for treating them. 

• Constipation: An over-the-counter stool softener or laxative may help. There are also medications specifically formulated to treat opioid-related constipation. 
• Nausea: This affects about ⅓ of people who take opioids, and often decreases after a few days. Your loved one may be able to take medication to ease nausea.
• Sedation: Some patients experience confusion, drowsiness or trouble breathing. This often improves within 3-4 days. If symptoms don’t improve, check to make sure the dosage isn’t too high.

Adjuvant Analgesics

Also called “helper drugs,” adjuvant analgesics are designed to manage specific types of pain in certain situations. Many can be used alongside opioids. Examples include the following: 

• Anti-inflammatory medications such as steroids or non-steroidal anti-inflammatory drugs (NSAIDS) may be used for nerve, bone or other types of pain.
• Antidepressants may help with pain caused by nerve damage. In addition, pain may be easier to treat if anxiety or depression symptoms are also well-managed.
• Anticonvulsants may be used for nerve pain or to control seizures.
• Local anesthetics block pain signals to specific areas of the body.
• Muscle relaxants are useful for pain caused by muscle spasms or tension. They may also help with anxiety symptoms. 
• Bisphosphonates can relieve bone pain and may reduce the risk of fractures. 

Pain Management Principles & Comfort Kits

Johns Hopkins Medicine offers three basic principles of pain management: 

• First, treat the pain right away, before it becomes severe. The longer you wait, the harder it is to treat.
• Don’t withhold pain treatment out of a fear of addiction. Proper use of pain medications under qualified medical supervision lowers the risk of dependency.
• A good rule of thumb is to follow a “step care” approach recommended by the World Health Organization.

The step care approach includes three levels of care based on the severity of the pain: 

• Step 1: If the patient is experiencing mild pain, start with an NSAID such as ibuprofen, or an alternative like acetamenophen.
• Step 2: If the pain continues or gets worse, a weak opioid like hydrocodone may be given, along with non-opioid medications.
• Step 3: If the pain still won’t go away or becomes more severe, a stronger opioid like fentanyl or morphine may be appropriate. 

Your hospice provider may also give you a comfort kit, also known as an emergency kit or e-kit. It lets you treat distressing symptoms quickly, without having to wait for a hospice team member to arrive. The kit will typically include pain medications, along with treatments for other symptoms like anxiety, nausea or breathing problems. Contents can be customized based on your loved one’s diagnosis and specific treatment needs. 

At Crown Hospice, our care team provides customized pain management to improve your loved one’s quality of life. If you need more information on our hospice care services, please call us at 361-575-5900 or contact us online.