Reports of overuse of pain and antipsychotic medications in nursing homes only add to the anxiety of already fearful caregivers when it comes to managing their loved ones' pain. Whether in an assisted living home, skilled nursing facility or in a hospice program, caregivers are often a barrier to effective pain management in the elderly.
This stems in part from a lack of communication from the medical professionals recommending medications to help control pain. Often, caregivers are fearful that their loved one may become unresponsive, sleep more often or exhibit strange behavior when taking narcotics.
The morphine debate
The hospice industry has struggled with this issue for many years. Science Dailysays this is called the "principle of double effect," or the notion that while morphine is an effective treatment for severe pain, it also hastens death. But according to an abundance of research gathered over the past 20 years, morphine does not shorten life or hasten death. It's also a well-tolerated medication with a wide therapeutic range, and its sedative effects don't last long.
When used appropriately to treat pain, opioids rarely cause addiction. The WHO Pain & Palliative Care Communications Program defines addiction as a psychological dependence on a substance. Physical dependence and tolerance are different from addiction, and both are expected to occur with continued opioid use.
Caregiver fears on pain management
Caregivers may have beliefs and misconceptions about pain medication, according to the International Association for the Study of Pain. Some are fearful their loved ones will become addicted, while others are concerned about severe side effects, such as sedation, nausea or constipation. Even patients themselves can resist pain management due to their own fears, such as feeling inadequate should they complain of pain.
If patients ask for pain medication, caregivers often fear they're developing an addiction, when in most cases they're simply trying to better manage their pain. Even staff in skilled nursing facilities can resist dispensing pain medications, substituting less powerful analgesics to avoid the potential for their patients to become addicted.
All of these factors can lead to a gap in communication between caregivers, patients and medical professionals. If fears aren't addressed when the medication is prescribed, caregivers may avoid dispensing the medication often enough or may give lower doses, causing their loved one unnecessary pain.
It's important for medical professionals to address any patient or caregiver concerns when recommending any treatment, especially pain management. Clearly explaining what addiction means and providing relevant data can ease caregiver fears. When used appropriately and for the management of pain, analgesic medications can be highly effective therapies that can keep loved ones comfortable with a low risk of addiction.