Feb 26, 2007
By: Bonnie Darves
Docguide.com

SALT LAKE CITY, UT — Patients in hospice or palliative care sometimes are reluctant to accurately describe their pain to doctors and nurses, or to speak openly in the presence of family members, which may set in motion a chain of events whose net result is inadequate pain management.

Opening the lines of communication, while difficult at times, may be key to turning poor pain management into an effective solution and avoiding common misconceptions about opioid use.

Denice Economou, MN, CNS, AOCN, oncology nurse specialist and senior research specialist, City of Hope National Medical Center, Duarte, California, discussed the use of opioids in pain management in a presentation here on February 17th.

Her presentation on February 17th at the annual assembly of the American Academy of Hospice and Palliative Medicine (AAHPM), outlined several strategies that can improve patient care by improving communication among all parties involved in end-of-life care.

"Many patients don't want to be perceived as weak or as addicts," she said, "or fear that worsening pain" may indicate disease progression. All situations may prompt patients to avoid discussing solutions to the pain they are experiencing, preventing effective management, she said. Further confounding the issue in certain cases, patients' family members who have similar concerns may emerge as roadblocks to appropriate prescribing and pain control.

In either situation, opening communication — by staging family and care-team conferences and letting patients know that using opioids as needed to control pain does not mean they are addicts — could lead to optimal medication use, Economou said. "It's important to get doctors, nurses, and pharmacists on the same plan," she said, and to include patients and family members as appropriate in interdisciplinary discussions about what might be required to alleviate pain.

Physicians and nurses who treat such reluctant patients should understand the myriad psychological and psychosocial issues that may contribute to patients' tendency to withhold information that could improve pain management. Those issues include, among others:

· tendency toward stoicism or concerns about being viewed as "a whiner";
· desire to be a "good" (as in non-bothersome) patient;
· fears about opioid addiction or side effects, or ultimately, tolerance to prescribed opioids.

When those issues arise, Dr. Economou said, it is important to reassure the patient and family members that pain control likely can be achieved without turning the patient into an addict. "You have to get the patients to trust [the team] first," she said, and to try to entice family members to share their hopes for the patient. That discussion often leads all parties to more actively accept pain-management strategies the physicians and nurses propose.

The research was supported through an educational grant from Cephalon, Inc.


[Presentation title: Techniques for Eliciting Causes and Modifiers of Pain. Opioids in Palliative Care and Hospice]

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