? regarding pain management....

Specialties Hospice

Published

Specializes in Geriatrics.

I had originally posted in the general nursing forum and got some great responses to our problem. For any of you who had read my posts I am glad to say we finally were able to get hospice in for my grandfather. What a wonderful blessing I think hospice is!!

My grandpa has had pain in his head for about the past 5 weeks ever since he suffered ANOTHER stroke. He is tired, and had made his wishes known that he wants NO MORE treatment, he doesn't even want to go to the Dr office anymore. He has been suffering for a long time, has CHF, ESRD just a ton of things going on and he has accepted the fact that his time to go home is near. Hospice came in and put him on liquid morphine (that is Roxonal, correct?) and also a fentanyl patch. Whithin the first 6 hours he was pain free, for the first time in WEEKS, he was actually comfortable. My mom heard from "a friend" that she couldn't believe they would put him on fentanyl because so many people have died from it. So, my mom got online and has been reading about people that have died from the patch. Now some in the family are concerned that my grandma will "over-medicate" him and kill him due to the amount of narcotics, instead of him dying naturally (hope that makes sense). I keep trying to stress that he isn't going to get better, he knows that, the hospice RN has told the family that. He is dying and hospice is there to keep him comfortable. I am just glad he isn't in pain, as is he. I guess I am just asking if the combo of morphine and fentanyl is common to use in hospice care, i was under the impression that it was. I have seem many people on both. I was also told that you cannot overdose on Roxonal, that is why the hospice pt is allowed to have it as often as needed. Is that true, or is it being that the person in near the end of life the amount of med doesnt matter.

i apologize if this all sounds confusing, my family is driving me nuts!! They wanted hospice to come in and now they are questioning the stuff they are doing for him. And as far as i am concerned hospice is doing an awsome job, THEY got him comfortable!!

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Yes, it is very common to see pt's on both a long acting pain medicine (which the fentanyl patch is) and a short acting pain medicine(which the Roxanol is) The patch is giving him a steady continuous dose of pain medication and the Roxanol is given in case he has "break through" pain. You can overdose on any narcotic, but I would worry more about if your grandfather is comfortable. You will not "overdose" him if he is appearing uncomfortable and it is given. The Roxanol will also be helpful if he starts to have any respiratory distress, which is common. It will help slow his breathing down and make his breathing easier. The reason why people have died from fentanyl patches is because they have been too high of a dose. If Hospice is involved, I would not worry about this. They know how to titrate medicines like this.

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Doodlemom is correct. In addition to the reasons given above, it is essential to have a short acting immediate release form of pain medication to use with fentanyl patches because it takes some time to be absorbed and reach its peak effectiveness and also because it begins to wane in effectiveness towards the end of the 72 hour period.

Being in constant pain is very stressful on the body and the spirit. Some patients actually outlive their prognosis while under hospice care because once their pain is finally under control, they feel so much better that they regain their will to live, they eat better, sleep better, interact with family again, etc.

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

Sorry to hear of your grandfather but the other posters are correct, Fent patchs take a while to work after placement and roxanol is the perfered method for break through pain. I have given ungodly amounts of pain medication to hospice patients and dont think twice about it. dying naturally hurts (according to alot of docs ) and there is no need to dye in pain when hospice can manage that . Your grandfather will die of his disease process and hopefully pain free. I come into contact with this all the time if your give him morphine you will kill him...this is sad and hospice really needs to educate families like this. I had a patient die the other day and the granddaughter was a cardiac MD, she refused roxanol and demanded we give tylenol supp...are you kidding, cancer pain and then turning the patient over for a worthless tylenol. But no one could talk sense into her and the patient died in horrible pain...good luck to you and your family ....

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I'm sorry to hear about your grandfather. Fentynal is OK but, we use Methadone at our hospice along with roxanol for the short acting. Methadone has much fewer side effects esp. in the elderly, i.e. constipation, orthostatic hypotension and confusion. Very well tolerated.

In 6 years I have only had 1 pt who couldn't tolerate it, gave her hallucinations.

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One thing to keep in mind is that some time patients are in so much pain or struggling so to breathe that once their pain or breathing is relieved and they are finally more comfortable they are able to let go and they pass away very comfortably and "naturally". It took me quite a while to realize that it wasn't something I had done but it was the fact that when you are in so much pain or are struggling so to breath you can't let go. The patients are really in control of when they die. If you've been around hospice patients much you will learn that they will wait for several days for a loved one to vist when you just don't see how they can hang on or wait for a relationship to be healed. I know that I go through the argument with so many of my patients and their families about pain meds. Especially the older population. I have one lady who won't even take Tylenol. She says she's not going to get "hooked up on all those drugs". She's a hoot! I have made my family promise that they will make sure I'm comfortable when the times comes. If I'm terminal and die a couple of hours earlier than I would have without the Morphine then that's GREAT! Who wants to lay there a couple of extra hours in pain???

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I am happy that your grandpa is finally pain free. Try to reassure your mom about the duragesic patch. A while ago, they were using Duragesic in the post-op recovery on pt's who have never been on Duragesic and started at a high dose. Subsequently, they died. Of course, in your Grandpa's case it is different.

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Just an idea, but maybe show this thread, to your mom (except for the part that said your family is driving you nuts!).

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