06 May 2009

Pain management

In palliative care, pain control is a basic human right. Patients and caregivers should be trained in pain control so the patient can still enjoy a high quality of life.

The palliative care team will be responsible for managing the patient’s pain and other symptoms. These may be related to breathing problems, fatigue, depression, nausea, and bowel or bladder issues.

Family members or caregivers should alert the doctor/palliative care team as soon as possible, since early treatment leads to more effective results. If the pain is severe, the doctor may prescribe some form of medication such as morphine. Relaxation techniques, massage, warm and cold packs on painful areas and emotional support all help to alleviate pain.

How important is pain management in palliative care?

According to Dr Teresa Swart, part-time lecturer in palliative care at Stellenbosch University who is currently completing her masters degree in palliative medicine, says pain management is “extremely important” in palliative care.

“Many patients sometime underreport pain, because they expect if you have cancer, you will have pain and its part of your suffering, but they don’t have to suffer and that is what we try to prevent.”

She says with effective pain control, the patient can enjoy a good quality of life. However, she emphasises that it is important to understand how to exercise pain control.

Elizabeth Scrimgeour, Executive Officer of the Drakenstein Palliative Hospice and Chairperson of the Western Cape Hospice Palliative Care Association, says the palliative care team also have to be quite open to altering their way of doing things. “If you really believe that the patient is the head of the team then you really have to fit in with the needs of the patient. If the patient doesn’t want to take pain medication, you have to manage around that.

“It’s a very tricky way of managing medicine because the last word stays with the patient but it’s a very satisfying way. It’s about empowerment of the patient and the family to take control of their own lives.”

Should the family or caregiver be involved in pain management?

Swart says most hospices are run as outpatient or home-based care units, where the patient is cared for at home by the family, with the assistance of the nursing staff from the hospice. This necessitates involving the family in the patient’s pain management.

She says the patient as well as the family gets trained in order to help with pain control. It differs at each hospice, they’ve got different protocols but the basic things are same. “They make a lot of use of the patient’s family or the carers that are involved. They are trained how to give medicine, when to give it and there’s always backup support for them if they need advice from the nursing staff.”

(Thania Gopal, Health24, April 2009)

Caring for the sick, Nursing the ill, the disabled, children and the elderly, The Authorised Manual of St. John Ambulance, St. Andrew’s Ambulance Association, The British Red Cross Society, 2nd ed. (1988) Dorling Kindersley Ltd.
Dr Teresa Swart, Part-time lecturer in palliative care at Stellenbosch University, currently completing her masters degree in palliative medicine.

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