Question about Pain

...the act of dying (ie the moment of death itself) is not painful at all - it's the disease which leads to death that can be painful.

Death is not always painful, and doesn't have to be - depends which disease you have and how well managed (or not) it is. Some diseases which are fatal do not hurt at all. Additonally, it's different for everyone. No two patients follow the same path.

Morphine PCA pumps tend not to be used - if you are referring to the pump which the patient presses to get a 'boost' of painkiller. As the patient becomes unresponsive as they draw near to death, they will be unable to press the button and, sad to say, there are some families out there who will press the button many many times in an attempt to 'hurry up' the process.

We use morphine pumps (and many other types of drugs) in a driver which delivers a controlled dose continuously - without the boost function. It's a very fine process of checks and balances to get the dosage just right, but on the whole it works well.

hope this helps.

I have noticed over the 7years Ihave been doing hopice that pt's that have not had pain, all of a sudden start having it. I explain it to my families this way. as the pt declines, they move around less and stay in bed more. Just the act of being in bed can cause pain.(if I'm in bed over a few hours, my back kills me). they start getting stiff and it hurts them , mostly when they are being moved and turned. occ we do get pt's that never have pain and we use the morphine sl to help with breathing.

Granted, my experience is limited, but from what I've seen so far death is not necessarily painful, but it is hard work. I've seen more effort than pain in my transitioning patients.

This is the way I learned it: Morphine is used because it causes peripheral blood vessel dilation, which causes increased pooling of blood in the peripheral vessels while reducing the amount of blood being returned to the lungs. Less blood in the lungs means less fluid accumulating in there, which eases the work of breathing. The pain control is a secondary benefit.

I hope I got that right.

n (emphasis added)

Also sad to say, there are families who won't press the button at all, because the Pt is "too sedated".....as though they're going to carry on a conversation with a loved one who is moaning in pain.

Please remember that not all pain is physical. Some people really don't experience a great deal of physical pain at end of life. But emotional or spiritual pain is very real and must also be addressed. Morphine is a frequently used opioid for pain and dyspnea for several reasons including that it has no specific "ceiling" for dosing, it is very effective for both symptoms, and it is inexpensive. When you couple that with the fact that it can be administered in a variety of ways it is a very attractive medication for symptom management.

Some people have very specific ideas about pain and suffering at end of life. Our hospice currently has a patient who believes that she must "suffer" to fully embrace/experience her spiritual path. I will admit that it is difficult for hospice professionals to allow people to remain in the high level of pain that this woman is experiencing...but...she gets to decide and we will honor her wishes. One of the biggest obstacles we have to overcome is the misinformation and fears that people have about use of opioids in terminal patients. Asking people what "addicted" means to THEM will frequently help them come to terms with the use of these drugs. Families who do not want to sedate the painful loved one often respond well to reminders that we must be responsive to the PATIENT'S needs emotionally and physically rather than theirs. They often just do not realize that they are putting their own interests ahead of their loved ones. Finding the tactful way to communicate that can be challenging.

This is a rewarding job and the frustrations are far out-numbered by the victories!