It is widely recognized that Hospice and Palliative Care encompasses the physical, psychological, social, and spiritual needs of patients, together with support for their caregivers. Fundamental to this is good symptom control-if patients have uncontrolled symptoms then addressing the other domains of care is often unachievable. Therefore, pain management comes first when addressing the list of concerns for the patient’s comfort.
The key elements to symptom control include assessment, diagnosis, treatment, and reassessment. The treatment falls into pharmacological and non-pharmacological modalities.
The Need for a Holistic Approach:
Hospice philosophy includes a holistic approach where non-drug, “complementary therapies” are added to the medication regime to assure the relief of pain. In most cases, a complementary therapy regime, such as Guided Relaxation Exercises, for example, used in conjunction with an appropriately prescribed pain medication will often help to achieve significant pain relief for a terminally ill patient. In addition, the hospice staff address the emotional, social, mental, and spiritual issues of the patient and family members. This combination of care offers a significant amount of assistance in an end-of-life situation.
*The patient should be told before a medication is given, even if you think he or she cannot comprehend the information.
*Frequently assess the pain level of the patient by asking him or her the level of the pain. If the patient is able to speak, do not assess the pain simply by his or her behavior. Some people will laugh or make jokes to mask their pain. Behavior is NOT always an indicator of pain! *PLEASE SEE MORE DETAILED INFORMATION BY CLICKING ON THE “EDUCATION” TAB ON THE HOME PAGE ON THIS WEBSITE. THEN CLICK ON “END-OF-LIFE PAIN MANAGEMENT” (SPECIFICALLY “PAIN ASSESSMENT” AND “WHAT IS TOTAL PAIN?”).
Appropriate use of any medication that may or may not be prescribed by the hospice physician, including morphine or other pain medications, haloperidol, lorazepam, metoclopramide, atropine eye drops, if given as directed generally yields significant symptom improvement without causing dangerous adverse effects and certainly without hastening death. If you have any concerns about any side effects in the friend, loved one or patient you are caring for, call the hospice physician or nurse immediately!!
For more detailed information on specific medications commonly used in hospice care, their common side effects, how they are best used, when they are contraindicated with other medications, etc. please see the extensive chapter on Pain Management as well as the chapter on Complementary Therapies (For Comfort Care) in The Final Journey–Complete Hospice Care for Departing Vaishnavas by Susan Pattinson, RN (Torchlight Publishing). Please go to the “Store” page ( See the Tab on the HOME page) on this website to order your copy of “The Final Journey.”