Is there pain with organ failure?

[mc3, ASN, RN]

I have asked this question of many hospice nurses, but is there any data or information available specifically regarding pain in organ failure in dying patients? Some say "of course" some say "no" but most say "Gee, I really don't know". Any thoughts?

Thanks,

mc3:)

[talaxandra]

When we withdraw treatment from these patients they don't usually need analgesia - they become increasingly drowsy, then unconscious.

Patients I've looked after with terminal liver failure that was caused by cirrhosis for example - rather than, say, cancer - have had discomfort from ascites that resolved as the fluid was reabsorbed, but not otherwise.

I've had only limited expereince with death from terminal respiratory and cardiac disease - shortness of breath seems to be more distressing than pain.

Hope that helps :)

[Chaya, ASN, RN]

In my experience with pts with renal or hepatic failure they feel really sick with the accumulation of toxins but aren't experiencing specific pain per se.

[leslie :-D]

i agree w/chaya.

in hepatic failure when there's ascites, it's not pain but definitely uncomfortable and impacts their respiratory status.

in esrd, toxins accumulate in the body which produce nausea, pruritis, but also have observed that once uremia sets in, they are less restless and more at peace.

but truthfully, when i see multi-organ failure, my pts are usually already medicated so unless something is blatantly obvious, sometimes it can be hard to assess.

hepatic failure is one that's easier to treat.

leslie