Probably the most demanding physical need of a dying person is the control of pain. Physical pain is actually divided into two major categories: acute and chronic.
Acute pain is pain that comes on quickly in response to a specific injury or malady, can be severe, but lasts a relatively short time. It is an indicator that something is wrong either in our environment or within our bodies. For example, a person who cannot feel the pain from a hot object is in danger of being burned. An even more important example is the sharp pain on the right side of the abdomen that can arise when a person has life-threatening acute appendicitis. Obviously then, our ability to perceive acute pain is desirable and is necessary for life. The presence of acute pain is just as likely to be experienced by a dying person as it is by anyone else. In her book Until We Say Goodbye
Dame Cicely Saunders, a founder of the modern hospice movement, reminds us that a toothache hurts just as much when a person is dying. For the comfort of the dying person, acute pain should be addressed just as it would be for anyone else.
Contrary to acute pain, chronic pain persists or progresses over a long period of time and is often resistant to medical treatments. Chronic pain does not provide any of the important warning signals that acute pain does. It is not diagnostically helpful nor does it warn us of any environmental dangers. For those with a terminal illness, chronic pain is usually associated with the disease that will result in death. Whether it is dull or sharp, constant or intermittent, chronic pain can consume a person’s attention and cause great distress. Proper care for those with chronic pain requires that it, and the associated distress, be managed and diminished as much as possible. Modern medical technologies provides many tools to help insure that a dying person’s final days do not have to be focused on his/her pain to the exclusion of all else.
Drug Treatment of Pain
The challenge in pain management is to find the most effective combination of medication, dosage (without over- or under-medicating), and method of administration. When the correct drug is given at a level that is no greater than that required to control pain, the pain can to be considered to be well managed. The choice of which medication to use can depend on the source of the pain such as inflammation or pressure. The most common drugs for pain management are opiate-based such as morphine.
Contrary to common belief, including some medical practitioners, most dying persons can tolerate large doses of narcotics without becoming "doped up," "knocked out," or addicted. The goal of pain management is not to cause total unconscious (anesthesia), rather a reduced sensitivity to pain (analgesia). The fact that a dying person in great pain does not become addicted to strong narcotics, even in high doses, is well supported by research. There is no addictive psychological "high" and the craving for greater and greater amounts of the drug does not occur. Even though there is no addiction, there can still be a physical dependence on the drug such that withdrawing it abruptly will have unpleasant physical ramifications. Surprisingly, once an individual learns that his/her pain really can be controlled, it is not unusual for him/her to become less fearful of expected pain and less anxious. This greater sense of security often leads to a reduction in the level of medication required to still be effective.
Psychological Components of Pain
As important as drug therapy is for managing pain, it is not the only resource. Another important consideration is the psychological component of pain. Pain is an individualistic experience. Pain thresholds and perceptions vary from person to person so what is extremely painful to one person might not be so for another. An overall plan to manage pain may also include working with the person to increase the pain threshold or alter the nature of the pain perception. Therapies to help accomplish these include biofeedback, guided imagery, meditation, therapeutic touch, self-hypnosis, etc. An interesting book related to the psychological components of pain is Healing Into Life and Death
by Stephen Levine.
Other Physical Dimensions of Care
Pain is not the only physical problem that needs to be addressed by caregivers. Others that can be just as distressing, if not more so, include constipation, diarrhea, nausea, vomiting, difficulty breathing, weakness, and difficulty swallowing. Some of these may be the result of the physical condition of the dying person and some may be side effects of the medications being given. Appropriate care requires also trying to alleviate these physical symptoms.