Managing pain during a terminal illness

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1 Managing pain during a terminal illness Summary Pain management is a key part of palliative care. The healthcare professionals in your palliative care team will work together to manage your pain so that you can focus on the things you enjoy. The most common and effective ways of reducing pain are through the use of pain-relieving medicines, physical or occupational therapies, complementary therapies (such as acupuncture and massage) and cognitive behavioural therapy (CBT). Use a pain diary and medication chart to keep track of your symptoms and prescribed medication. Most opioid medication used in palliative care is provided through the Pharmaceutical Benefits Scheme (PBS), which means that the Australian Government covers most of the cost. If you cannot afford your medication, talk to your doctor so they can prescribe medication you can afford. Pain management is a key part of palliative care. If your pain is well managed, you will have a better quality of life. You are likely to sleep better and have more energy during the day. If you feel less pain, it means you can be more active, which also reduces your risk of pneumonia, blood clots and bedsores, which are associated with a lack of mobility. Working together to manage your pain The healthcare professionals in your palliative care team, including your local doctor or specialist, carers, nurses, palliative care professionals and allied health professionals, work together to enhance your quality of life. This includes doing everything they can to manage your pain so you can focus on the things you enjoy. The most common and effective ways of reducing pain are through the use of pain-relieving medicines, physical or occupational therapies, complementary therapies (such as acupuncture and massage) and cognitive behavioural therapy (CBT). Start by writing down the details of your pain and any concerns you may have about your treatment options and then speak to your healthcare team about the right pain management plan for you. Choosing your treatment The type of pain you are experiencing will affect which pain medication or treatment your healthcare team prescribe. Factors that will affect your treatment choices include: the location of the pain the severity of the pain the type of pain such as sharp, tingling or aching whether the pain is persistent, or comes and goes what activities or events make the pain better or worse current medications how much current medications ease the pain the impact the pain has on lifestyle, such as poor quality of sleep or loss of appetite. Talking to your doctor about your pain Being honest with your doctor is one of the best ways to make sure you get the right type of treatment and care that will help you manage your condition. When talking to your doctor about your pain, let them know: Managing pain during a terminal illness Page 1 of 5

2 when the pain started what time of the day it happens and how long it lasts how often it happens, such as daily or continuous pain anything you ve done that makes your pain better or worse what you have done to try to manage the pain and if it worked if the pain stops you from doing anything. Write down anything else you think might be relevant, such as: any change in your diet your physical activity the medications you are taking, dosage and how often sleeping patterns and any sleeping aids you use new life events or circumstances that may be causing stress. Managing your pain at home You can lower your everyday levels of pain by learning some self-management skills, such as coping with depression and stress. By working on these skills while taking your pain-relieving medication, you give yourself the best chance of better quality of life. Deep physical and mental relaxation reduces anxiety and can help you cope with ongoing pain. Your doctor may be able to recommend reputable therapists for natural pain relief. Otherwise, ask friends or contact the professional association for your chosen therapy and ask for a list of members in your area. Helpful therapies may include: Heat or cold heat packs can aid relief of chronic musculoskeletal injuries and associated pain. An ice pack can be used to help reduce swelling immediately after an injury, such as after a fall. Physical therapies walking, stretching and strengthening may help relieve pain, depending on its cause. Physical activity can also help you stay active and improve your mood. Ask a physiotherapist or osteopath to design a program specifically for your pain condition. Breathing and relaxation scientific studies have shown that correct breathing technique, using the diaphragm and abdomen, can soothe the nervous system and manage stress. Hypnotherapy uses imagery to induce a dreamy, relaxed state of mind. Hypnotherapy can also help to ease some of the side effects of cancer treatment, such as nausea. Massage soothes muscles, encourages relaxation and increases circulation to the area being massaged. Meditation is the deliberate clearing of the mind to bring about feelings of calm and heightened awareness. The regular practice of meditation offers many long-term health benefits, such as reduced stress and blood pressure. Tai chi is a Chinese form of non-combative martial arts that consists of gentle movements to clear the mind and relax the body. Yoga is an ancient Indian system of postures that are done in time with the breath. Other natural pain relief techniques that may be helpful to ease chronic pain include: Acupuncture this ancient form of Chinese medicine involves inserting and stimulating fine needles into specific points of the skin. Scientific studies have proven acupuncture to be an effective treatment in some pain syndromes, but there is little research into cancer pain. Transcutaneous electrical nerve stimulation (TENS) therapy a very small electrical current is passed through the skin via electrodes, causing a pain-relieving response from the body. Always check with your doctor before beginning a new type of pain management treatment and follow their instructions carefully to avoid making your pain worse. Ask your doctor questions Managing pain during a terminal illness Page 2 of 5

3 Asking your doctor questions not only helps you understand what is happening with your body but also helps you make decisions relating to your condition. When describing test results and treatment options such as surgery or the side effects of different medication, your doctor may use words you don t understand. Ask your doctor to explain something again if you don t understand it. Pain diaries and medication charts If you are having difficulty keeping track of when your symptoms occur, how often and for how long, it is a good idea to consider using a pain diary. By writing down details of your pain every time it occurs, your healthcare team can chart your progress and make sure your medications are working correctly. Medication charts are also useful tools. They can help you to remember to take your medication, take the right dose, and chart the progress of your symptoms. Talk to your doctor or palliative care provider about setting up a pain diary or medication chart. Alternatively, download a pain diary or medication chart from the Palliative Care Victoria Resource Library. Pain relief medication Pain relievers (also called analgesics) are used a lot in palliative care, however, many of them are common medicines that people use throughout their lives. There are two broad categories of analgesics: Non-opioid such as aspirin and paracetamol that are mainly used for mild to moderate pain. Opioid such as morphine, codeine and oxycodone that are mainly used for severe pain. Medications available for pain management include: paracetamol aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen these medicines reduce inflammation (redness and swelling) opioid drugs, such as codeine and morphine these medicines treat moderate to severe pain local anaesthetics. Managing your pain medication Always follow instructions for taking your pain relief medication safely and effectively. By doing so, your pain is more likely to be well managed, you are less likely to take larger doses of medication, and you can reduce your risk of side effects. It s best to take medications for chronic pain regularly. Talk to your doctor or pharmacist if your medicines lose their ability to reduce your pain or are causing you other problems, such as side effects. These are more likely to occur if you are taking pain relief medications for a long time. Always let your doctor know if you are taking (or are about to take) any other prescribed or over-the-counter medication, herbal remedies or natural supplements. Tell your doctor how regularly you take them and the dosage. Some medication or natural supplements may clash with other medication you take and affect how well they work. Keeping track of your medication If you are finding it hard to remember when and how much medication to take, talk to your doctor about getting a medication chart to help you keep track of what you are taking. Weekly medication organisers can help and are also available at local chemists. Keep a good supply of your pain medication on hand so you do not run out. Side effects of pain medication Like any type of medication, there may be side effects to using pain relief medication. But most of these are Managing pain during a terminal illness Page 3 of 5

4 temporary or can be managed easily. Possible side effects include constipation, nausea and vomiting, drowsiness or confusion, dry mouth and itchy skin. Speak to your doctor immediately if any of these side effects occur so they can change the dose or type of medication. Cost of pain medication Most opioid medication used in palliative care is provided through the Pharmaceutical Benefits Scheme (PBS), which means that the Australian Government covers the bulk of the cost. If you cannot afford your pain medication, talk to your doctor so they can prescribe medication you can afford. Most branded medication is also available through generic brands at a lower cost. Speak to your pharmacist about finding lower cost pain medication that has the same active ingredient. You are entitled to extra discounts through the PBS if you hold any the following cards: Australian Seniors Health Card Health Care Card Pensioner Concession Card Department of Veterans' Affairs (DVA) Gold, Orange or White Card. Concerns about opioids You may have some concerns about taking opioids. You may be worried about becoming addicted to morphine or that by taking it you will hasten your death. This is not true. Taking opioids does not shorten your life and, when prescribed by a doctor to relieve pain, does not lead to addiction. You may also think that it is better to wait until you are very ill before you use these drugs. However, evidence shows that it is far better to find a suitable opioid and use it regularly from the time when your pain becomes constant. This makes it easier to maintain the activities and interests you enjoy, therefore enhancing your quality of life and general wellbeing. Talk to your doctor or palliative care professional about any questions and concerns you have so you can get the information you need to put your mind at ease. Where to get help Your doctor Your palliative care provider Your pharmacist Palliative Care Victoria, call (03) NURSE-ON-CALL, call Medicines Line (Australia), call 1300 MEDICINE ( ) Managing pain during a terminal illness Page 4 of 5

5 This page has been produced in consultation with and approved by: Better Health Channel - (need new cp) Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions. For the latest updates and more information, visit www. Copyight 1999/2017 State of Victoria. Reproduced from the Better Health Channel (www.) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. Managing pain during a terminal illness Page 5 of 5

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