How Is Pain Controlled By Hospice?

One of hospice’s main purposes is to control symptoms such as pain and they do that extremely well 95% of the time.
Pain is more than just physical. The concept of “total pain” must be addressed: pain is like a “four-legged stool” which includes physical, social, psychological, and spiritual aspects; ignore any one of them and “the stool tips over” because we haven’t controlled the problem.
That said, most pain control starts with milder drugs, such as acetaminophen, then moves to those such as tramadol [Ultram] or the anti-inflammatories [such as ibuprofen], and finally to the most potent—the opioids [narcotics derived from opium].
Opioids include morphine, methadone, codeine, hydromorphone [Dilaudid], hydrocodones [such as Lorcet], and oxycodones [such as Percocet]. Morphine remains the gold standard, used by hospices and palliative care teams everywhere because it: is inexpensive; can be taken by tablets or liquid, or injected, or applied to the skin; and has no maximum dose—I’ve had people take over 600mg per day—whereas mixed compounds such as “Lorcet” have limits due the acetaminophen.
Other methods to help control pain include: nerve blocks, radiation, massage therapy, music, stopping non-comfort drugs, exercise, meditation, prayer and acceptance. For that 5% of patients who fail to respond to all these measures, there are still some options available and I’ll discuss them next time.