Many older people experience chronic pain. According to Statista, 36% of seniors over 65 years have protracted pain, and for 13.5%, the discomfort is especially severe. While most pain management programs focus on palliative care, hospices specifically focus on pain care for seniors nearing the end of their lives.

Aim of Hospice Pain Management

The primary aim of a hospice is to help improve the quality of life for elders who suffer intense pain. The cost of hospice care is covered by Medicaid and Medicare for those who are terminally ill and have around 6 months to live unless they receive care. Hospices offer a range of services to minimize pain and discomfort, including medication, therapy and companionship.

Why Use Hospice for Pain Management?

Seniors in assisted living communities under the Bethesda Senior Living Communities umbrella can make use of hospice services in their homes or at a hospice. The staff at hospices understand a great deal about palliative care for pain and the importance of balancing quality of life and medical care. Their primary goal is to make you comfortable and allow you to live a normal life during your period of care.

Hospice teams may also recommend complementary treatments such as physiotherapy and massage to relieve stiffness and sore muscles.

What Is Chronic Pain?

Chronic pain is constantly present. The symptoms of continuing soreness may vary, but there's no effective medical treatment to cure that discomfort. It may be caused by a physical disorder like osteoarthritis or because of cancer or another debilitating illness. Some seniors experience musculoskeletal pain caused by joint degeneration and disease. Others may have neuropathic pain caused by nerve damage and diseases that affect the central nervous system, such as diabetes or shingles.

Effective treatment for enduring pain is a key consideration for improving mental health and preventing anxiety and depression.

Challenges of Treating Senior Pain

Most medical experts agree that chronic pain should always be treated early. This helps keep the discomfort under control and stops it from getting worse.

Doctors need to consider the side effects of medication in elderly people who have severe medical conditions. Some types of medication may damage the kidneys, and the liver may have difficulty breaking down certain medications. The absorption rates of certain drugs may also be influenced by changes in the stomach.

You can be reassured that hospice care staff understand these issues and are well-versed in managing chronic pain in seniors.

Assessing Pain          

One of the first steps the hospice care team takes is to assess the intensity of pain so they can devise a suitable treatment protocol. These tools are helpful for situations where seniors can't easily communicate the extent of their agony.

Pain Assessment Tools

The doctor or health care worker typically chooses one of three assessment methods, depending on the senior's ability to explain their symptoms. These include a numerical score, the Wong-Baker rating and the FLACC assessment scale:

• Numerical pain score: This is a simple test that uses a 10-point scale, where 0 means no pain and 10 indicates the agony is extremely intense.
• Wong-Baker: Created for children, the test is good for seniors who have limited communication skills. It consists of 10 pictures with facial expressions that show different levels of pain.
• FLACC: The FLACC test is suitable for people with dementia or who can't communicate. It consists of an assessment of behavior such as facial expressions, leg movements, body movements, crying and consolability that together indicate the degree of pain.

Hospice Pain Medication Protocols                        

The primary intent of the hospice pain medication protocol is to make the person as comfortable as possible. The intensity and type of palliative care are balanced against minimizing the discomfort and the senior's ability to function as normally as possible.

Medications Used for Controlling Pain

The primary medications used for palliative care are standard analgesic medications for less severe discomfort and opioid-based painkillers.

• Stage 1 pain: The most common medications for mild to moderate discomfort are nonsteroidal anti-inflammatory drugs (NSAIDs). These help reduce swelling and inflammation. For those who can't take NSAIDs because of kidney or stomach issues, the doctor may prescribe acetaminophen.
• Stage 2 pain: For more severe pain, the doctor may prescribe a milder opioid such as hydrocodone, sometimes with a nonopioid analgesic medication.
• Stage 3 pain: For very severe pain, the hospice may administer strong opioids like morphine and fentanyl.

Helper Medications

Other medications that may be prescribed include strong anti-inflammatories like steroids, especially for nerve or bone pain. In some instances, the provider may use a local anesthetic or a muscle relaxant.

Misconceptions About Pain Medications in Hospice

You may have concerns about the risk of addiction through the use of opioid painkillers prescribed for your loved one. Experience when using these medications in a hospice situation for severe discomfort has shown there's little risk of addiction, especially when balanced against the quality of life and effective relief. Better pain management usually means your loved one will live longer and in more comfort.

Starting Hospice Care Early

If you or your loved one is experiencing severe and unrelenting pain from a long-term illness or condition, starting hospice earlier will ensure better pain and symptom control. In most instances, you can get hospice care in your Bethesda home or apartment. Having hospice care also means easier access to necessary medical supplies and equipment and allows couples to spend more time together.