Thursday, March 20, 2014

Chronic Pain, Terminal Illness, and Palliative Relief

By Lily McCann

Palliative pain relief and care is an issue that is often in the spotlight, and in 2014 the World Health Organization is sponsoring a resolution to help ensure that people with life-threatening and terminal illnesses have access to palliative care and pain relief. One of the most important aspects of medical care for someone with a terminal illness is recognizing and treating pain when it occurs. The World Health Organization’s new resolution could positively impact the lives of tens of millions of people worldwide—among them the more than six million who die every year without the benefit of palliative pain relief. Access to palliative pain relief is severely limited in low-income and middle-income countries, despite its extreme importance in the lives of people with chronic pain and terminal illnesses.

Chronic pain and palliative care are complicated issues, partly because of out-dated ideas about palliative care itself, and partly because of the complex emotional toll that chronic pain and terminal illness take on people who are affected by them.

Palliative Treatments are not only for End-Of-Life Care

Palliative care and pain relief is typically thought of as being associated with terminal illnesses such as cancer, but it can also be part of a treatment plan for people with chronic pain disorders, acute illnesses, and treatable injuries and health conditions. The word palliative simply refers to the prevention and relief of suffering, and doesn’t necessarily imply that the pain is caused by a terminal illness. In contrast, curative treatment is that which focuses on curing an illness, rather than treating the symptoms it causes. Palliative healthcare is separate and distinct from treatment-oriented care, because palliative care focuses on alleviating and preventing pain and discomfort, but not on curing the condition that is causing the pain. This is the main reason why palliative care and pain relief is most often associated with terminal incurable illnesses, though it can be part of treatment plans for chronic and curable diseases—even something as simple and innocuous as the aches and pains caused by flu, which can be alleviated with ibuprofen without actually curing the illness.

The confusion about the nature of palliative care also stems from its link to hospice care and end-of-life care, both of which are associated with treating people with terminal illnesses. Hospice care is a form of palliative care, but palliative care isn’t a form of hospice care—the two terms aren’t interchangeable. Another issue is that many doctors still believe that palliative care is only appropriate for people for whom curative treatment isn’t an option. This unfortunately means that even in high-income countries, many people with chronic illnesses aren’t receiving treatments that could help relieve pain and other distressing symptoms, at a much lower cost than the emergency clinic visits they must often resort to.

Alleviating the Emotional Toll of Chronic Pain

Chronic pain that requires palliative care can be devastating emotionally as well as physically. Health problems and chronic pain are a significant cause of depression, particularly in older adults. The constant physical and mental stress of chronic pain takes such a toll that it can cause people to feel helpless and hopeless, and these feelings can all too easily deepen into depression. For someone living with chronic pain or a terminal illness it’s therefore important to consider the emotional consequences and take steps to prevent depression setting in. Support from friends and family plays an important role, but it’s particularly important that support is both realistic and non-judgmental—telling someone with a terminal illness that “everything will be okay” isn’t realistic, and telling someone with depression or chronic pain to “snap out of it” isn’t supportive. Rather, find ways to be helpful, and bear in mind that pain and illness can be isolating and lonely, and often all that’s required of you is your presence.

Finally, always remember that while chronic pain and terminal illness can change the way people look and behave, it doesn’t necessarily change who they are inside: never make the mistake of being patronizing or of infantilizing someone, or of treating them as though they are their illness. Instead, try to look for ways to connect that don’t necessarily focus on the person’s health, while still recognizing that their health may place limitations on them that shouldn’t be overlooked.

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