Symptom management is an essential component of quality palliative care
Pain is a common symptom and one that people with a life limiting illness worry about the most. Thankfully not every person will develop pain but for those that do the vast majority of pains can be relieved or controlled. Pain is distressing, exhausting and makes it difficult to enjoy life. Therefore it is important that you speak with your doctor if you develop pain so that it may be controlled as quickly as possible. Waiting until the pain gets worse may make it harder to provide good relief.
Palliative care aims to keep you as free from pain as possible and to keep any persistent pain to a minimum. This can be achieved through the use of medications which may be taken as tablets, liquid or even patches applied to the skin. Medicines are available to control pain safely without causing addiction or hastening death. In some cases your doctor may recommend other treatments, such as a short course of radiotherapy that may reduce the amount of medication you require.
Further information on Pain Management in Palliative Care may be found here;
Palliative Care Australia “Learn More About Pain Management” ;An electronic brochure with information on pain management. Includes a section on what you can do to assist with managing your pain at home.
Palliative Care Australia “Facts about morphine and other opioid medicines in palliative care”: An electronic brochure that provides further information on pain, information on the different ways morphine is used and dispels common myths about opioids (or morphine-type medications) that people may have heard.
CareSearch, the Palliative Care Knowledge network website has a section about pain and pain management. It also contains links to other online resources about pain managed by palliative care.
Other Common Symptoms
Nausea is the unpleasant feeling that you are about to vomit. Vomiting is the forceful release of the contents of your stomach through your mouth. Some people can be nauseous for long periods without vomiting. Other can vomit without feeling nauseous for more than a few seconds before hand. There are many different causes of nausea and vomiting and many types of treatment available. Your doctor or palliative care team can work out why you have nausea or vomiting and help to prevent or control it. If you are feeling nauseous, it may be a good idea to eat smaller meals more frequently rather than three large meals a day until you can see your doctor about further treatment.
Palliative Care Victoria produces a pamphlet on Nausea and Vomting in Palliative Care. An electronic version may be downloaded from here.
Many conditions, such as lung diseases, cancer, heart failure or motor neurone disease, can cause an unpleasant feeling of being short of breath or breathlessness. This is called dyspnoea and it often causes the person feeling short of breath to panic, which can make things worse. If dyspnoea develops then your doctor will try to identify the cause of your shortness of breath and provide the appropriate treatment.
In some cases, after you have seen your doctor and been prescribed appropriate treatment, your doctor may also recommend the following measures to assist you when you feel short of breath:
- modifying activities that you know cause you to become breathless e.g. getting someone else to shower you;
- sitting up straight;
- trying to take deep slow breaths rather than short, quick, panicky breaths;
- trying to relax, often this is easier if you have someone with you to help calm you down;
- A fan blowing air across your face may also help to relax your breathing.
Constipation is when you no longer have regular bowel movements. For some people it may refer to stools being hard to pass. Constipation can be a cause of abdominal pain which is often cramping in nature. It can also be a cause of restlessness for older people. It may seem strange at first, but your palliative care team will be very keen on talking to you about your bowel habits a lot! This is so as to prevent any problems developing down the track.
A lot of the stronger pain relief medications can cause constipation and your palliative care team should organise a laxative (a medication to help your bowels move) when you start morphine or related opioid medications. Your bowel habit may also vary depending on your diet, water consumption, how hot a day it is or how active you are. This means that you may need to vary the amount of prescribed laxatives you take depending on how your bowels are going. Keeping a diary of your bowel habit, (how often you go, whether the motions were hard or soft, how much you were passing etc), may help you and your palliative care team decide how much laxative to take.
In a worst case scenario, constipation associated with vomiting, abdominal pain and swelling of the belly may be a sign of bowel blockage or obstruction. Please seek medical advice as soon as possible if those symptoms develop.
Signs of confusion include difficulty thinking or speaking, poor awareness of what is going on, restlessness or agitation. Confusion can be caused by a high temperature, new medicines, pain, and the effects of the disease. Seek help from your doctor or palliative care team. They will check for, and treat, any conditions that may be contributing to the confusion. Confusion can clear up rapidly if the cause can be treated. It could be due to a full bladder or rectum, or an infection that can be treated. Sometimes confusion due to medication clears as the person’s body adapts. Sometimes a change of medication is needed.
It is normal to have changing feelings and emotions. This is especially true if you are seriously ill or facing the end of life. It is also normal to experience intense feelings when someone close is seriously ill.
Even though these feelings are intense, they can be difficult to describe. They are not always easy to understand or cope with. They can affect different people in different ways. They can affect the manner and way that you take in and accept information. They can affect how you make decisions. Information in this section looks at some of these emotional challenges. (Caresearch)