Pain Medication in Hospice Care: Separating Fact From Fear

By Emmanuel Hospice

Pain medication has an important role in hospice care: helping patients find relief from pain to enhance their quality of life. Yet misconceptions about opioids, particularly morphine, create fear around medications that are intended to provide comfort.

Medical Director Dr. Jordan Sall with Emmanuel Hospice is passionate about providing education and reassurance around medication use in hospice, where the goal of care shifts from curing disease to maximizing quality of life. Understanding that shift can help put common myths and concerns into perspective.

“We want to help patients live as comfortably as possible for as long as possible and be able to make the most of every moment for the time they have,” Sall said. “Pain itself can cause suffering. When effectively managed, it can allow people to get out of bed, move more freely, enjoy visits with loved ones and get adequate rest — all things that make the body, mind and spirit feel better.”

Treatment is tailored to the individual

Hospice teams do not automatically use heavy pain medication for patients. Instead, they assess each patient’s needs and tailor treatment to their pain type and severity. Determining the right medication and dose also involves considering the patient’s underlying disease, previous medications, potential drug interactions, side effects and other factors.

“A pain treatment plan is very individualized for each patient,” Sall said. “Medication is only prescribed to address specific symptoms and at the appropriate level with the patient’s goals in mind.”

Morphine offers practical benefits

Morphine is an opioid often used in hospice because it can be provided in liquid form. Sall said liquid morphine is useful because it is easier to administer when swallowing is difficult and the amount can be gradually adjusted to find the right dose.

Respiratory depression, which is when breathing becomes slow and shallow, can be caused by opioids, but when given in low doses with slow adjustments, clinicians can ensure patients get just enough medicine to relieve pain and shortness of breath at the end of life.

Comfort and alertness can be balanced

Drowsiness from medication, also known as sedation, is another common concern. Sall said this can occur when pain medication is first started or a dose is increased, but often improves within a few days. Hospice clinicians work to find the right balance between comfort and awareness.

“More isn’t always better,” Sall said. “We want to achieve pain control without patients getting sleepier. That’s the threshold. Persistent sedation in a patient would prompt a dose adjustment or a reconsideration of their medication plan.”

Many options for pain management

“Opioids are one tool in the toolbox,” Sall said, “but they’re far from the only one.”

Depending on the patient’s needs and wishes, pain management options can include non-opioid pain relievers and even non-medication approaches, such as body positioning, use of heat or cold, massage therapy, anxiety treatment, clinical music therapy, spiritual support and other symptom-specific interventions.

“We can address pain in multiple ways beyond pain medications,” Sall said. “We are all about meeting people where they are at and finding ways take a patient’s mind off pain through different outlets.”

Ultimately, pain management in hospice is not about following a predetermined formula. It is about listening to the patient, understanding what matters most to them and continually adjusting care to support those goals.

For more information, call 616.719.0919 or visit EmmanuelHospice.org.