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Managing Severe Pain At End Of Life - On Death And Dying
The elderly experience loss in many ways to which the young are oblivious. Loss of physical attributes, employment, roles, friends, diminishing senses, and the sorrowful loss of a loyal, trusted companion, their pet. Many elderly pet owners find it difficult to choose pet cremation as an option. The idea of incineration may conjure unpleasant reminders of the atrocities committed during World War II. In addition to that notion, friendly neighborhood crematoriums are not their usual address book entry.
Perception and availability are obstacles for a practical opportunity to honor an old friend and promote the healing process. Traditionally, pets are buried in the owner's yard, if they have one, or a pet cemetery. Turning the family member over to the local veterinarian calls for an unceremonious disposal in a landfill.
Let's begin by examining some of these fears that we may have about giving opioid medications and then we can separate fact from fiction.
1)You should only take the smallest amount of (opioid) medication to be comfortable; if you take more than that, the medication won't work later when the pain is worse.
Yes, this is a common misperception, especially with cancer patients. It is true that the dosage of pain medication that you take today, will not work as well several weeks from now. But restricting your medication use now and choosing to be uncomfortable, will not have any bearing on your comfort in the future. All patients who take opioids can expect that their bodies will get used to the dose they are currently taking and that the same dose will not work as well over time. This tolerance to the medication will make it necessary to continually increase the dose. This is not a problem because there is no limit to the amount of opioid medication one can receive. The truth is that most pain is very controllable (estimated at 97%), no matter where the person may be in the course of their disease.
Unmanaged pain is the greater worry here. It causes problems with sleeping and eating both of which can weaken someone, make them prone to infection and ruin their quality of life. In addition, when someone is in pain, they are afraid to move as it increases their pain. Their immobility leads to other health problems. Uncontrolled pain eventually causes depression and hopelessness. The key to controlling pain is to make sure that the person is receiving enough pain medication regularly that they have little or no pain. They should not have to wait for the pain to come back before they can get pain medication. So give the medication regularly. When the person is in bed all the time, they should receive enough medication regularly so that they can be able to be moved in bed without moaning or grimacing.
2)If I give too much medication, they may become addicted.
Addiction is a chronic brain disease that can occur with some people who are exposed to opioids. That being said, there are very few patients who become addicted while being treated for pain. The addiction rate of patients being treated for pain is estimated at less than .1%. If you truly fear addiction, it is important to ask yourself, "if my loved one did not have pain, would they want to continue to take this pain medication?" Most people would answer "no." People who become addicted to pain medications are taking pain medications for reasons other than pain. The bottom line is that the likelihood of becoming addicted is very low and fear of addiction should not be a barrier to comfort.
3)If I give this medication, it may cause my loved one to die sooner.
This is incorrect. There is research that demonstrates patients who take opioids for pain actually live longer when their pain is well controlled. This makes sense as when they are comfortable, they will be able to maintain their weight and get adequate rest. When medications are given properly, there is no risk that their death will be hastened. When people are actively dying, they need to continue to receive the pain medication. When they start to sleep all the time, it's tempting to reduce the dosage because you want them to be awake and talking to you. But remember that at some point they will be too weak to respond. Cutting back on the medication will bring their pain back at a time when they are less able to tell you that they are in pain. They will then require consecutive doses of opioids to control the pain again.
Life goes on with change complimenting loss. The frequency of either is accelerated in the elderly. Without good coping mechanisms, this natural process takes an unforgiving toll. Awareness and planning of inevitable events soften the devastation the death of a pet can have. Funeral services provide a time to mourn and dignify the animal's life at the time of their death. Grief becomes acceptance, a vital stage for the elderly, so that depression does not become a clinical problem. Another pet at the proper time signifies change necessary in any lifespan
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