Hospice Pain Management; An Interdisciplinary Approach Lori Stewart, RN, CHPN and Andrea Scheve, MM, HPMT, MT-BC

2 Definitions of Pain Understanding is Key to Successful Management Unpleasant physical sensation: the acutely unpleasant physical discomfort experienced by somebody who is violently struck, injured, or ill "cried out in pain" Unpleasant physical sensation: the acutely unpleasant physical discomfort experienced by somebody who is violently struck, injured, or ill "cried out in pain" Feeling of discomfort: a sensation of pain in a particular part of the body Feeling of discomfort: a sensation of pain in a particular part of the body Emotional or Spiritual distress: severe emotional, spiritual, or mental distress "the pain of rejection" Emotional or Spiritual distress: severe emotional, spiritual, or mental distress "the pain of rejection" Somebody or something troublesome: somebody or something that is extremely annoying or causes many problems Somebody or something troublesome: somebody or something that is extremely annoying or causes many problems Current Medical Definition – whatever the patient says it is, always believe the patient Current Medical Definition – whatever the patient says it is, always believe the patient The 5 th Vital sign The 5 th Vital sign

3 Pain Scale

4 Dimensions of Pain: One or more can effect Quality of Life Physical Physical Emotional Emotional Spiritual Spiritual Psychosocial Psychosocial

5 Types of Pain: Treatments vary/change based on type Acute -Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection. Expected to have an end point. Acute -Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection. Expected to have an end point. Chronic - Pain that lasts beyond the term of an injury or painful stimulus. Can also refer to cancer pain, pain from a chronic or degenerative disease Chronic - Pain that lasts beyond the term of an injury or painful stimulus. Can also refer to cancer pain, pain from a chronic or degenerative disease Breakthrough - Acute periods of pain that come on rapidly despite the use of pain medication. May occur spontaneously or during a specific physical activity. The pain "breaks through" the normal control. Breakthrough - Acute periods of pain that come on rapidly despite the use of pain medication. May occur spontaneously or during a specific physical activity. The pain "breaks through" the normal control.

6 Medication Management: Every person is an individual Comfort Pack Comfort Pack –Morphine –Compazine –Tylenol Suppository –Ativan –Haldol –Atropine –Other NSAIDS - Ibuprofen NSAIDS - Ibuprofen Opioids - Morphine Opioids - Morphine Antidepressants - Prozac Antidepressants - Prozac Antihistamines - Benadryl Antihistamines - Benadryl Anxiolytics - Ativan Anxiolytics - Ativan Amphetamines - Caffeine Amphetamines - Caffeine Anticonvulsants -Tegretol Anticonvulsants -Tegretol Steroids - Prednisone Steroids - Prednisone

7 Non-Pharmacological Pain Tx Relaxation Relaxation Massage Massage Breathing Techniques Breathing Techniques Biofeedback Biofeedback Imagery Imagery Hypnosis Hypnosis Cold or Heat Cold or Heat Acupuncture Acupuncture Distraction Distraction Emotional Support and Counseling Emotional Support and Counseling Spiritual Support Spiritual Support

8 Pain and Grief Hospice patients are often facing numerous losses, the loss of independence, the loss of their health, and possible losses of loved ones. Hospice patients are often facing numerous losses, the loss of independence, the loss of their health, and possible losses of loved ones. Grief can magnify the pain experience. Grief can magnify the pain experience.

9 Case Study 1: Bud

10 Case Study 2: Steve

11 Case Study 3: Rebecca Thompson, MT-BC

12 MT Techniques Song selection Song selection Live singing/instrument playing Live singing/instrument playing Music prompted reminiscence Music prompted reminiscence Music therapy relaxation techniques (MTRT) Music therapy relaxation techniques (MTRT) Iso principle Iso principle Song writing Song writing Song parody Song parody Legacy projects Legacy projects

13 Thank You!