hospice pain management; an interdisciplinary approach lori stewart, rn, chpn and andrea scheve, mm,...

Hospice Pain Hospice Pain Management; An Management; An

Interdisciplinary ApproachInterdisciplinary Approach

Lori Stewart, RN, CHPNLori Stewart, RN, CHPN

andand

Andrea Scheve, MM, HPMT, MT-BCAndrea Scheve, MM, HPMT, MT-BC

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Definitions of PainDefinitions of PainUnderstanding is Key to Understanding is Key to Successful Management Successful Management

• Unpleasant physical sensation: Unpleasant physical sensation: the acutely unpleasant the acutely unpleasant physical discomfort experienced by somebody who is physical discomfort experienced by somebody who is violently struck, injured, or ill "cried out in pain" violently struck, injured, or ill "cried out in pain"

• Feeling of discomfort: Feeling of discomfort: a sensation of pain in a particular a sensation of pain in a particular part of the bodypart of the body

• Emotional or Spiritual distress: Emotional or Spiritual distress: severe emotional, severe emotional, spiritual, or mental distress "the pain of rejection" spiritual, or mental distress "the pain of rejection"

• Somebody or something troublesome: Somebody or something troublesome: somebody or somebody or something that is extremely annoying or causes many something that is extremely annoying or causes many problemsproblems

• Current Medical Definition Current Medical Definition – whatever the patient says it – whatever the patient says it is, always believe the patientis, always believe the patient

• The 5The 5thth Vital sign Vital sign

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Pain ScalePain Scale

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Dimensions of Pain:Dimensions of Pain:One or more can effect Quality One or more can effect Quality

of Lifeof Life• PhysicalPhysical

• EmotionalEmotional

• SpiritualSpiritual

• PsychosocialPsychosocial

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Types of Pain:Types of Pain:Treatments vary/change based Treatments vary/change based

on typeon type• Acute -Acute -PainPain that is usually temporary and results from that is usually temporary and results from

something specific, such as a surgery, an injury, or an something specific, such as a surgery, an injury, or an infection. Expected to have an end point.infection. Expected to have an end point.

• Chronic - Chronic - PainPain that lasts beyond the term of an injury or that lasts beyond the term of an injury or painful stimulus. Can also refer to cancer painful stimulus. Can also refer to cancer painpain, , painpain from a from a chronicchronic or degenerative disease or degenerative disease

• Breakthrough - Acute periods of pain that come on rapidly Breakthrough - Acute periods of pain that come on rapidly despite the use of pain medication. May occur despite the use of pain medication. May occur spontaneously or during a specific physical activity. The spontaneously or during a specific physical activity. The pain "breaks through" the normal control.pain "breaks through" the normal control.

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Medication Management:Medication Management:Every person is an individual Every person is an individual

• Comfort PackComfort Pack– MorphineMorphine– CompazineCompazine– Tylenol SuppositoryTylenol Suppository– AtivanAtivan– HaldolHaldol– AtropineAtropine– OtherOther

• NSAIDS - IbuprofenNSAIDS - Ibuprofen

• Opioids - MorphineOpioids - Morphine

• Antidepressants - ProzacAntidepressants - Prozac

• Antihistamines - Antihistamines - BenadrylBenadryl

• Anxiolytics - AtivanAnxiolytics - Ativan

• Amphetamines - CaffeineAmphetamines - Caffeine

• Anticonvulsants -TegretolAnticonvulsants -Tegretol

• Steroids - PrednisoneSteroids - Prednisone

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Non-Pharmacological Pain Non-Pharmacological Pain TxTx

• RelaxationRelaxation

• MassageMassage

• Breathing Breathing TechniquesTechniques

• BiofeedbackBiofeedback

• ImageryImagery

• HypnosisHypnosis

• Cold or HeatCold or Heat

• AcupunctureAcupuncture

• DistractionDistraction

• Emotional Support Emotional Support and Counselingand Counseling

• Spiritual SupportSpiritual Support

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Pain and GriefPain and Grief

• Hospice patients are often facing Hospice patients are often facing numerous losses, the loss of numerous losses, the loss of independence, the loss of their independence, the loss of their health, and possible losses of loved health, and possible losses of loved ones. ones.

• Grief can magnify the pain Grief can magnify the pain experience.experience.

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Case Study 1: BudCase Study 1: Bud

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Case Study 2: SteveCase Study 2: Steve

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Case Study 3: Rebecca Case Study 3: Rebecca Thompson, MT-BCThompson, MT-BC

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MT TechniquesMT Techniques

• Song selectionSong selection

• Live singing/instrument playingLive singing/instrument playing

• Music prompted reminiscenceMusic prompted reminiscence

• Music therapy relaxation techniques (MTRT)Music therapy relaxation techniques (MTRT)

• Iso principleIso principle

• Song writingSong writing

• Song parodySong parody

• Legacy projectsLegacy projects

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Thank You!Thank You!