[Gompers]

Originally Posted by sophie2

Thanks for all the great input. Do you think there is any truth in the statement, " as a patient's level of conciousness decreases, so does their awareness of discomfort"? If they do not react to a painful or noxious stimulus, would you assume they are feeling no discomfort?

I would err on the side of caution and provide pain medication in the same amounts that the patient required before the coma. And again, if the patient was on narcotics before, you can't just stop them or their body will be in silent agony from withdrawl.

[subee]

Originally Posted by sophie2

Thanks for all the great input. Do you think there is any truth in the statement, " as a patient's level of conciousness decreases, so does their awareness of discomfort"? If they do not react to a painful or noxious stimulus, would you assume they are feeling no discomfort?

Patients in surgery are certainly unconscious but they certainly react to noxious stimuli quickly if they haven't received enough analgesic drug. Tearing and heavy sweating will occur with lots of patients who are too "light".

[jCLNC]

Our medical director, an oncologist and pain medication specialist, and the director of our Hospice for 24 years, says that if a patient is comatose, if you continue to give more opiods you will hasten their death. A truely comatose patient cannot feel pain. He orders Lorazepam to help agitation, but nothing else. If your patient is exhibiting non verbal signs and symptoms of pain, I don't believe they are truely comatose.

[Gompers]

Originally Posted by ax433cs92dds

Our medical director, an oncologist and pain medication specialist, and the director of our Hospice for 24 years, says that if a patient is comatose, if you continue to give more opiods you will hasten their death. A truely comatose patient cannot feel pain. He orders Lorazepam to help agitation, but nothing else. If your patient is exhibiting non verbal signs and symptoms of pain, I don't believe they are truely comatose.

But what about withdrawls? Whether the patient is comatose or not, their body may be still addicted to opioids. If they are going through a silent withdrawl, I would think that, too, would hasten death. Just wondering.

[mvanz9999]

Originally Posted by ax433cs92dds

Our medical director, an oncologist and pain medication specialist, and the director of our Hospice for 24 years, says that if a patient is comatose, if you continue to give more opiods you will hasten their death. A truely comatose patient cannot feel pain. He orders Lorazepam to help agitation, but nothing else. If your patient is exhibiting non verbal signs and symptoms of pain, I don't believe they are truely comatose.

If a patient is comatose and terminal....why does it matter. I doubt it makes much difference whether they live another 5 days in a coma or not. At this point, quality of life is essentially non-existant.

[earle58]

theoretically, if it's an actual coma, the pt is totally unresponsive to any type of stimuli and so, would not feel pain.
and that is the basis of conscious sedation in hospice, that the anesthetic induces the pt into a coma-like state and pain is no longer experienced.
but w/o actual diagnostics in assessing the level of unconsciousness, it is preferable to err on the side of caution.
as long as it is a debatable subject, then no one knows for sure.
and so, you do what is ethical.

i don't think taking a comatose pt off of opioids, would hasten death.
it could certainly create a paradoxical irritability w/rebound htn, tachycardia, diaphoresis, seizures, etc.
but any prudent md would taper them off, and not abruptly stop.

leslie

[EmptytheBoat]

Originally Posted by ax433cs92dds

Our medical director, an oncologist and pain medication specialist, and the director of our Hospice for 24 years, says that if a patient is comatose, if you continue to give more opiods you will hasten their death. A truely comatose patient cannot feel pain. He orders Lorazepam to help agitation, but nothing else. If your patient is exhibiting non verbal signs and symptoms of pain, I don't believe they are truely comatose.

I agree with you and your medical director. For a truly comatose patient, I utilize ativan for restlessness; will use an opiod to treat SOB if needed. Good discussion here, thanks