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Pain is whatever the patient says it is. It may be physical, emotional, spiritual or social. In addition, emotional or spiritual pain can make physical pain worse. For example, physical pain might cause anxiety, which could lead to depression. Depression can cause insomnia, which can make the physical pain worse.
Pain may be communicated verbally and actively or non-verbally with grimacing, restlessness, moaning or a furrowed brow. Family and friends play a vital role in assessing the pain level. Hospice staff may ask questions about pain, including:
- Is it sharp?
- Is it constant or intermittent?
- Is it a crushing or a pressured feeling?
- Is it an old pain or a new pain?
What to look for:
- A pattern to pain
- Difficulty in sleeping
- A lack of interest in the things the patient once enjoyed
- A lack of concentration
What to do:
- Take pain medication on a schedule, even if it means setting an alarm. It is easier to prevent pain than to control pain once it has begun.
- Make sure the nurse knows when medicines are down to a three-day supply so there is time to get a refill.
- Massage
- Heat or cold application
- Distraction (music, TV, talking)
- Relaxation
When to call hospice:
- If the pain is new or severe
- If the pain is causing other symptoms, such as insomnia, nausea, constipation, confusion, inability to walk, eat or urinate
- If the patient is not able to take the medication by mouth
- If the medication for "breakthrough pain" is not effective and the pain continues to be a problem between the long acting doses of medication
- If the patient needs the medication more frequently than prescribed. For example, if the medication was ordered for every 4 hours, but the patient feels the need for more at the end of 3 hours.
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