Pain – managing it for someone else.
See a loved one in pain, especially if they are having difficulty explaining their pain is really hard to watch. You can look at their broken body and be sure that they are in pain – they just must be – you only have to think about their injuries! But pain can be a personal thing, some people are far more stoic than others.
So if your loved one cannot explain in words their pain, how do you know? Do they flinch or grimace? Are there any changes? Does something affect their response? Do they shift their position? And what can be done to help them?
Firstly, contact their doctor to discuss pain medication. How pain is usually clinically managed, which is to prevent over sedation is to climb up a “pain ladder”, so pain relief is estimated and then generally started at a low level. Pain relief can also be given regularly or on an “as required” basis for “breakthrough” pain. So you can have constant pain relief or just when it gets really bad or a combination of both.
So having been given pain relief for a few days, to see how they get on, the loved one should be under constant monitoring to find out if this level of pain relief is enough. So are they still grimacing? Do they display shifting movement? Do they look like they are unhappy or hot or cold? Even when very sleepy and non-communicative, people tend to shift their bodies about rather than lying in a relaxed manner. And again, if it is safe to lightly touch them somewhere, see how they respond to being touched, they might appreciate the comfort of human touch and you can then feel through your hand any flinching or shift in their body as well as visually observing it.
If they are still in pain, then generally pain relief is increased about 20% per rung of the “ladder” and as the pain relief goes up, the person can become more sedated. The end stage of some diseases are very painful and so pain relief increases and they become more sedated, eating and drinking less, until their body finally shuts down potentially from both the underlying disease and / or lack of hydration and nutrition. As pain relief increases there is a really careful balance when the person is really poorly, as too much pain relief or too big an increase can trip over the line of providing comfort into assisted dying. Assisted dying in the UK is illegal, as it is in many other countries and the healthcare professionals are very cautious in this area of care to stay within the bounds of legality.
This balance at the end of life is really important, if someone is dying a painful death, then they should be provided relief from that pain and sadly the pain relief can make them more sleepy and in truth, this could to bring about their death more quickly than without it, but no-one should die in agonising pain! What the professionals cannot do is actively take steps to expedite death, just make it more comfortable.
And for the carers watching it, it is an awful experience. Just awful!