Pain is often the most feared symptom in the last days of life. Pain management can be simple or complex, according to its cause. Do not ignore pain, as that may only make it harder to manage. Some types of pain are more difficult to manage than others. That is why it is important to talk with the healthcare team, letting them know whether the medication has worked well or not.
When managing pain it helps to have a record about the type of pain that the person experiences (for example what words the person uses to describe it), and when it occurs, and then discuss this with the healthcare team when they next visit. The healthcare team will check the Carer Diary you will be keeping that records the medications you have given since their last visit. This will help them to decide if medications need to be changed.
There are many different types of medications that can be used to manage pain, but we will only concentrate on the medication that are commonly given as subcutaneous no- needle injections for people in the last days of life. Choosing the right drug to control pain can sometimes be difficult. Your healthcare team will consider all options and choose the medication that is best suited to the person’s individual pain.
There are many types of medications, so there is usually something that will keep the person you are caring for comfortable. Strong pain medications such as opioids are often used to manage pain. Table 1 outlines some of the commonly used opioids given subcutaneously, that help with pain control.
The healthcare team will make every effort to keep the person as comfortable as possible, though it may take some adjustment to get the medication right.
All strong pain medications have side effects that can usually be managed. Nausea/ vomiting, drowsiness or poor concentration and itchy skin typically only lasts for a short while after the person first starts to use strong pain medications. Constipation can be managed by taking laxatives regularly as long as the person you are caring for is still able to take medication by mouth.
Dry mouth is common too and can be a side effect of several other medications. If the person is still able to swallow safely, offer sips of water. Otherwise, try to increase their comfort by moistening the mouth (using a damp sponge) or applying lip salve.
Less common side effects, which, if experienced should be reported immediately to the person’s healthcare team include:
Addiction can occur when a person takes strong pain medications like morphine for recreational purposes. There is a misconception that when people have pain and need to use opioids that they too, can become addicted. This concern can lead to under- usage of strong pain medications and can lead to loss of pain control. Concern about physical or psychological dependence is never a reason to delay giving an opioid if it is required.
It is true that a person’s tolerance to a particular drug may increase and more medication may be needed as the illness progresses. This is quite normal but if you are concerned you should speak to the healthcare team of the person you are caring for. The healthcare team may alter the dose from time to time to ensure that the person remains as comfortable as possible.
|Name of drug||What is it used for?||How long does it take to work after subcutaneous injection?||Common side effects|
|Morphine Sulphate (Morphine)||20 minutes to take effect and peaks around 30-60 minutes|
|Oxycodone Hydrochloride (Oxycodone)||20 minutes to take effect and peaks around 30-60 minutes||See above|
|Diamorphine||20 minutes to take effect and peaks around 30-60 minutes||See above|
Check instructions left for you by the healthcare team. They will explain to you how often the medication can be given.
You may be given permission to give an extra dose of as-needed medication for pain one hour after the previous dose if this has not worked. If you give this extra dose, you should inform your healthcare team straight away. The doctor or nurse may wish to come to visit the person you are caring for.
Being allowed to give an extra dose after one hour may not be the best course of action for everyone so the decision will be made by your healthcare team who will discuss this with you.