Many professional and family caregivers deem increasing the amount of
prescription pain medication, for chronically ill people in pain, an
unacceptable act. Terminally ill people are literally dying with an
unnecessary amount of pain because of the negative stigma attached to
administering surplus pain-killing opioids when needed. Many family
caregivers and medical personnel are under the notion that upping doses of
painkillers can be fatal. In addition, some believe pain medications like
opioids, are a narcotic that is extremely addictive and includes heavy
side effects. But, a new survey published in the July 29, 2000 issue of
The Lancet suggests, “Increasing use of pain-killing opioids such as
morphine in terminally ill patients does not shorten life.”
Researchers reviewed the cases 238 patients who died
during palliative care in their institutions. The study was prompted by
public and professional concern that the use of opioids for symptom
control might shorten life. They retrospectively analyzed the pattern of
opioid use in the last week of life; the daily doses were low. However,
marked increases in opioids at the end of life did not significantly
influence survival, frequency of unexpected death, or description of
death.
The study challenges the myth that proper pain
control for end-of-life care means killing the patient. According to
Sandra Johnson, former president of the American Society of Law, Medicine
and Ethics and expert in the area of health law, pain management and care
for the elderly, “The problem is many people believe that pain
medication, like opioids, are addictive and have terrible side effects.
The fact is, the risk of addiction for someone who is receiving
end-of-life care, is irrelevant and side effects aren’t severe and
eventually clear up.” Some of the side effects attributed to opioids
include constipation, blurred vision and lethargy and eventually, a
person’s body will become acclimated to them.
Part of the problem in nursing and medical education
is that much of the research on the effectiveness and safety of pain
management is relatively recent and contradicts common knowledge of
earlier pain control practices. Some professionals in the medical
community think proper palliative or comfort care is euthanasia under a
different name. In the Lancet report, Drs. Andrew Thorns and Nigel Sykes
of St. Christopher’s hospicee in London said, “There is no connection
between competent symptom control and euthanasia. It is possible to
achieve good symptom control by using morphine competently, and you do not
shorten people’s lives when you do that.” Also, physicians feel
threatened by legal sanctions for treating patients in pain especially
when the treatment relies on the use of controlled substances. The report
recommends that if a doctor is seriously concerned about shortening a
patient’s life, they should consult a specialist in the field of
palliative care.
Another myth concerning pain control is that
over-the-counter pain medications, like ibuprofen, are much safer than
opioids. This perception is incorrect and according to Ms. Johnson,
“Large doses of ibuprofen are more dangerous and more harmful to the
stomach and liver, than we realize. Over-the-counter does not mean
safer.” Non-prescription pain relievers should be administered with
caution and still may not relieve pain properly.
Suffering doesn’t have to be a necessary part of
death. Ms. Johnson comments, “What we know now about pain management is
that, 95% of cancer pain can and should be relieved through simple means,
like morphine. In the past we were told not to medicate, that was then and
this is now.” She believes that drugs do not hasten death but pain may
hasten death.
Through good hard information, like The Lancet report,
the perception of treating pain by care professionals and the public
could transform. Family caregivers may want to communicate with their
doctors their interest in obtaining more information about certain pain
medications; because it is possible not all care professionals have read
the new research themselves. According to the study, our loved-ones do
not have to spend the last days of their lives in pain any more.
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