How early palliative care can help relieve pain and other symptoms

by Regina Tosca, LICSW, Clinical Social Worker, Palliative Care
December 4, 2017

People sometimes mistakenly think that accepting palliative care means they have to stop receiving other medical treatment. However, palliative care is a specialty service that can be provided at any point during a patient’s illness. That means that patients can receive palliative care while also receiving treatment to cure disease or extend their lives.

Related reading: 3 common misconceptions about palliative care and hospice

Our team frequently gets requests to help with pain management. Our doctors and pharmacists have expertise in recommending medications for pain. Our social workers and chaplains provide patients with information on non-medical approaches they can use to manage their own pain.

In addition to pain relief, we also help with other symptoms of illness or treatment. For example, we often see patients who have severe constipation, a common side effect of opioid-based pain medications that might be prescribed following surgery. Research in our field has shown that standard laxatives, such as colace, don’t relieve this type of constipation. We see some patients who report abdominal pain and it turns out they’ve gone days without a bowel movement because they’re on prescription opioids. In these circumstances, we educate not only providers on more effective means for treating symptoms, but also patients and families so they can advocate for better symptom management as they continue treatment.

In addition to addressing the physical symptoms of illness and treatment, our team also helps patients and families sort through feelings associated with being sick and in the hospital. Services such as spiritual care, supportive counseling and relaxation therapy are based on patient and family individual needs, and can help patients and loved ones cope with feelings of fear, sadness, frustration or grief.

It’s never too early for palliative care

The goal of palliative care is to maximize quality of life when patients are facing serious illness. Toward that end, we are working within the hospital to promote our involvement earlier in hospitalization or during evaluation for treatment planning. We call this approach “upstream palliative care.”

An area where this is working well is in the advanced heart failure program, where we meet patients who are preparing to undergo bypass surgeries, heart transplants or implantation of heart devices to extend their lives. We work alongside the advanced heart failure teams to help manage symptoms, but also to have discussions about the “what ifs,” the potential complications, and what patients and families might want if those occur. This is an aspect of palliative practice known as “advance care planning.” These can be difficult conversations, but they’re important as sometimes things don’t work out as we hope. It’s preferable, in our minds, to discuss the “what-if” scenario before facing a medical crisis.

We often work with patients who have chronic and progressive conditions, such as kidney disease, dementia or COPD. Over time as these conditions progress, patients come to the hospital more frequently for other problems related to the underlying disease. In these cases, we talk with patients and families about how being hospitalized all the time affects their lives, and whether a different plan of care, which may include hospice, would provide them with a better quality of life.

An important aspect of palliative care is to help both patients and medical teams consider the big picture. For example, we work a lot with patients who have advanced dementia or Alzheimer’s disease, which are progressive and incurable. Often, families will bring patients to the emergency room because they have stopped eating or getting out of bed, both of which are expected complications as the illness progresses. When this happens, families might ask about feeding tubes or home physical therapy. There are cases in which these interventions may make sense. However, when they don’t, we talk to families about options for less aggressive or invasive means of caring for their loved ones.

It’s about making sure our patients understand their options for care and can make informed choices. The earlier we’re brought into the process, the more options our patients can choose from—so they can live their lives on their terms.

Category: Healthy Living     Tags: end of lifepalliative carequality-of-lifeRegina Tosca