Pain Management in Palliative Care-A Detailed Guide for PSWs

According to the World Health Organization (WHO), only about 14% of people worldwide who need palliative care receive it. This highlights a significant gap in access to essential services designed to ease pain and improve quality of life. Most families seek palliative care for their loved ones to manage pain and provide comfort during these challenging times. In this comprehensive guide, we will discuss vital aspects of pain management in palliative care, offering insights, strategies, and essential information for Personal Support Workers (PSWs). 

Basics of Palliative Care:

A study published in the Journal of Palliative Medicine highlights that approximately 80% of end-stage patients experience moderate to severe pain. Therefore, it is crucial to address this issue comprehensively, focusing on the patient’s overall well-being and comfort.

Before looking into the specifics of pain management, let’s establish a foundational understanding of palliative care. Palliative care is a specialized approach aimed at improving the quality of life for individuals with life-limiting illnesses. It focuses on alleviating physical and emotional suffering and providing support for both patients and their families.

The Role of PSWs in Palliative Care:

PSWs play a vital role in managing pain by providing daily care and observing changes in patients’ conditions. They are often the first to notice subtle signs of pain or discomfort, making them crucial in the early detection and management of pain. Moreover, PSWs should be well-versed in the physical and emotional aspects of pain management, ensuring they provide holistic care that addresses all aspects of the patient’s well-being.

How Frequently Do Patients Experience Pain?

Pain is a prevalent issue in palliative care, affecting more than half of patients with advanced diseases like cancer, heart failure, COPD, and dementia. For instance, in a study of patients at the end of life, pain was reported by 81% of cancer patients, 69% of dementia patients, 68% of heart failure patients, and 57% of those with COPD. Severe pain was more common among cancer patients (35%) compared to those with non-cancer conditions (17-21%)​. 

Types of Pain in Palliative Care:

Pain management in palliative care can be complex, varying from patient to patient. Understanding the different types of pain is essential for effective management.

1. Physical Pain:

Physical pain can manifest as nociceptive or neuropathic pain. Nociceptive pain results from tissue damage or inflammation, while neuropathic pain arises from nerve damage.

2. Emotional and Psychological Pain:

Patients in palliative care often experience emotional distress and psychological pain due to their illness. PSWs must provide emotional support to alleviate these forms of suffering.

Read More: 5 Stages of Palliative Care at Home – Everything You Need to Know!

Assessing Pain Levels:

Accurate assessment of pain is the cornerstone of effective pain management in palliative care. PSWs should be skilled in evaluating pain levels through various methods, including:

1. Self-Report:

Encouraging patients to communicate their pain levels verbally or through pain scales is crucial. A patient may asked to choose from a scale of 0-10, with 0 being the mild pain and 10 being the excruciating pain they are experiencing. 

2. Observational Assessment:

In cases where patients cannot communicate, PSWs must rely on their observations to assess pain based on facial expressions, body language, and behavior.

Managing Pain:

Three important things about the pain that PSW must know;

• Pain should be dealt right away, any delay will make the pain worse.
• You must not be afraid of getting addicted to painkillers, if taken under the supervision of a healthcare professional, this is the last thing you want to focus on.
• Managing pain issues by following the WHO approach.

What is The WHO Approach to Pain Management?

The WHO Step-Care Approach is widely regarded as a simple, cost-effective, and systematic method for managing pain in palliative care settings, aiming to improve the quality of life for patients facing serious illnesses.

Step 1: Mild Pain

For mild pain, the approach starts with non-opioid analgesics, or non-steroidal anti-inflammatory drugs (NSAIDs). These medications are often used alongside adjuvant therapies, which can include medications for specific types of pain, like neuropathic pain, or treatments to alleviate side effects.

Step 2: Moderate Pain

If the pain persists or increases to moderate intensity, the next step involves adding a weak opioid, to the existing non-opioid medication. This combination helps manage moderate pain while minimizing the use of b opioids.

Step 3: Severe Pain

For severe pain, the WHO approach recommends switching to a b opioid while continuing the use of non-opioids and adjuvant therapies as needed. The goal is to achieve adequate pain control without causing excessive sedation or side effects.

Pharmacological interventions play a significant role in pain management in palliative care. PSWs should have a basic understanding of commonly used medications, including opioids and adjuvant medications.

Non-Pharmacological Approaches:

In addition to medication, non-pharmacological approaches can complement pain management strategies:

1. Physical Therapy:

Gentle exercises and movements can help alleviate pain and maintain mobility.

Examples of some physical therapy include;

1. Seated marching and short walks (Enhance leg strength and improve circulation). It helps patients with limited physical capabilities due to various conditions, Such as cancer, arthritis, and neurological diseases.
2. Gentle Stretching (Reduces muscle tension and improves flexibility, which can help alleviate pain)
3. Range of Motion Exercises (Maintains joint flexibility and prevents stiffness, which is especially useful for bedridden patients)
4. Deep Breathing and Relaxation Exercises (Help to manage pain by reducing anxiety and promoting relaxation, which can decrease the perception of pain)

2. Complementary Therapies:

Complementary therapies, such as massage, acupuncture, and aromatherapy, can significantly enhance the comfort and well-being of patients in palliative care. These therapies are often used alongside traditional medical treatments to help manage pain, reduce stress, and promote relaxation.

Communication and Advocacy:

Effective communication and advocacy are essential in palliative care. PSWs must actively listen to patients and observe non-verbal cues to understand their pain and emotional needs. They should advocate for pain relief by communicating concerns to the healthcare team and ensuring that care plans are adjusted accordingly. This includes educating patients and families about pain management options and fostering an environment of open dialogue, which helps improve the patient’s quality of life.

Read More: How to Improve Your Caregiver Communication Skills

Ethical Considerations:

Pain management in palliative care involves complex ethical considerations, such as balancing pain relief with potential side effects. PSWs must engage in ethical decision-making to provide the best care possible.

Here are the ethical considerations in one-line bullet points:

1. Balancing Pain Relief and Side Effects
2. Maintaining Professional Boundaries
3. Respecting Patient Autonomy (Honor the patient’s choices regarding pain management, even if they decline certain medications)
4. Continuous Ethical Education (Engage in ongoing training and reflection to navigate complex ethical decisions with compassion and professionalism)
5. Equitable Resource Distribution (Provide fair access to pain management for all patients, regardless of background or location)

The Importance of Documentation:

Accurate and detailed documentation of pain assessments and interventions is essential in palliative care. This practice ensures that all healthcare professionals involved in a patient’s care have access to consistent and comprehensive information, enabling them to track changes in pain levels and adjust treatment plans as necessary.

Coping with Emotional Challenges:

Working in palliative care can be emotionally taxing for PSWs. The nature of the work often involves dealing with end-of-life issues, providing care for patients in severe pain, and supporting grieving families, which can take a significant emotional toll.

To maintain their well-being and prevent burnout, it is crucial for PSWs to engage in regular self-care practices and seek emotional support. This could include activities such as debriefing sessions with colleagues, participating in professional counseling, or engaging in stress-relieving activities like exercise, meditation, or hobbies outside of work. 

Read More: How to Prevent Caregiver Burnout

Want to learn more?

Reach us at wecare@considracare.com and we will be happy to assist. Discover more tips in our information booklets or on our resources page.

Conclusion:

Pain management in palliative care is a multifaceted endeavor that requires empathy, skill, and dedication. PSWs play a crucial role in ensuring that patients experience comfort and dignity in their final journey. By understanding the types of pain, employing various assessment techniques, and utilizing both pharmacological and non-pharmacological interventions, PSWs can provide holistic care to their patients. 

FAQ’s:

1. How is pain managed in palliative care?

Pain in palliative care is managed through pharmacological (medications) and non-pharmacological (physical therapy, complementary therapies) approaches to alleviate suffering and improve quality of life.

2. What is the difference between pain management in palliative care?

Pain management in palliative care differs by focusing on enhancing comfort and quality of life for individuals with life-limiting illnesses, rather than curative treatments.

3. What are the methods of pain control?

Methods of pain control include medications like opioids and non-pharmacological approaches such as physical therapy and complementary therapies.

4. What is pain assessment in palliative care?

Pain assessment in palliative care involves evaluating pain levels through self-reporting from the patient and observational assessment for non-communicative patients.

5. What is the pathophysiology of pain in palliative care?

The pathophysiology of pain in palliative care varies but can include nociceptive pain from tissue damage and neuropathic pain from nerve damage, often exacerbated by the patient’s underlying condition.

Maryam Nasir

Maryam is a leading writer at ConsidraCare, specializing in senior care. Her well-researched articles are widely recognized for guiding families through the complexities of caring for loved ones, establishing her as a trusted and authoritative voice in the field.