In actively dying patients, adequate pain control frees them from suffering. “If people have severe pain, they can’t talk with their families, and they can’t do the other things that might be important to them, whether they’re dying or not dying,” says Dr. Chittenden. “We should be trying to address pain in all patients in the hospital, not just those who are dying. Those in the ICU, those who have just had operations, those who have chronic pain—it’s not OK for them to come to the hospital and be having terrible pain.”
Dr. Artz agrees: “I cannot imagine that it is good for healing if a patient’s sympathetic nervous system is revved up because they’re in severe pain. I believe that adequate pain control is a really important piece of helping people get better.”
Dr. Ling urges colleagues to put themselves in the patient’s shoes, asking themselves, “If I were the patient, what would I need to control my pain?” Everyone’s pain threshold is different, he asserts, and physicians should listen to their patients’ reports. “Rather than asking why would we need to prescribe a large dose of narcotics, ask, ‘Why wouldn’t you want to control the pain?’ ” TH
Gretchen Henkel writes frequently for The Hospitalist.
References
- Gordon DB, Stevenson KK, Griffie J, et al. Opioid equianalgesic calculations. J Palliat Med. 1999 summer;2(2):209-218.
- National Comprehensive Cancer Network Practice Guidelines in Oncology. Adult cancer pain. Available at: www.nccn.org/professionals/physician_gls/PDF/pain.pdf. Last accessed January 28, 2007.
- Wong DL, Hockenberry-Eaton M, Wilson D, et al. Wong’s Essentials of Pediatric Nursing. 6th ed. St. Louis: Mosby;2001:1301.