Hi,
I’ve noticed that people can disagree about the effectiveness of drugs for pain-relief…
Those who support euthanasia usually claim that some people with terminal illnesses live in pain which drugs can’t help relieve.
On the other hand, there are those who say how modern drugs and palliative care can relieve pain for everyone (or almost everyone).
So which is more accurate? Maybe some of the drugs that are effective have severe side effects that can be fatal - but even if they do, they still would be effective at relieving pain (while the person is alive)…
It seems like theres some mis-information (though I could be wrong on any of the following points.)
Some pain management techniques bring quality of life way down, such as very high doeses of morphine. Sure, you may be in less pain, but you don’t even know your alive since your damn near on the verge of coma, have no appatite, and addicted to a medicine that you will have to rely on hospitals for the rest of your life for.
See Above
If you wanted to get technical, even the most horrible pain could be killed by keep the patient asleep.
(When I started typing this, I had an actual point in mind that I wanted to make, I’ve since forgotten it, so I just leave before I start rambling)
Joey P
Kind of a tangent, but also, what about those Indian fakirs who can do seemingly painful things without appearing to be in pain? Maybe they’re in a “detached” state of mind that stops them from feeling the pain… and there are also those young people (often girls) who cut themselves with razor blades in order to deal with emotional pain… and there are masochists who can get sexual excitement from pain… maybe pain can seem less bad if you have a different attitude towards it…
Maybe different attitudes to pain could be combined with semi-high dosages of morphine…
Joey P:
Having to rely on hospitals or not isn’t that relevant… I’m wondering if the pain-relief treatment is effective or not… and I am talking about treatments that reduce pain while keeping the person fairly in touch with reality. (e.g. able to communicate with others)
Joey P, I must strongly disagree with your assessment about pain medication for the terminally ill. Have you a cite for those assertions? Greater than 98% of terminal or malignant pain can be managed with medications, chiefly opiate narcotics, without the complications you list.
QtM, MD
IME, when my mother was terminally ill, she was on fairly high doses of liquid morphine. This sometimes made her delusional, but kept her more or less rational until the end. Also, these days, there is a med called Fentanyl, which is often used, in transdermal patch form, on painful terminal illnesses. Fentanyl is much stronger than morphine, and because it’s delivered through the skin at a steady pace, side-egffects are kept to a minimum.
This shows a complete change of attitude from “the old days”, (as recently as the late 70,s as far as I know), when docs had drugs strong enough to control the pain, but were hesitant to prescribe them because they were highly addictive. Hospice was instrumental in getting such drugs for terminal cancer patients. You would think that it would have occurred to the good doctors that if you have less than a year to live, a morphine jones is not that big a deal.
What about the other 2%? Is their pain still relieved, though they experience bad side effects (near loss of consciousness, etc)? Or are there some people which no drug or treatment (including my idea of having a different attitude to pain, like ignoring it) can help?
Malignant pain doesn’t respond as well to attitude adjustment as chronic non-malignant pain.
Nerve blocks, spinal or regional anesthesia, and other invasive procedures can also be used to treat intractable pain.
I don’t believe there is any malignant pain syndrome that can’t be treated by some current modality. Addiction is not an issue in treating this type of pain. If the person should recover, treating a physical addiction (which occurs very uncommonly in this situation anyway) is not difficult.
My father died in intractable pain despite receiving high doses of morphine (he was receiving palliative care at the time).
Pain management (and especially the delivery of pain management medications) has come a long way since then, but I’ve still come across a number of people whose pain is unrelieved by the most potent pain medication available which will still leave them at least partially conscious (and here, it’s rare to find a physician who will deliberately induce and maintain unconsciousness to control a patient’s pain unless the patient has already entered a PVS).
Bear in mind that for a substantial number of terminally ill patients, pain is only one of the issues causing them distress - the combination of total dependence and pain coupled with absolutely no hope of improvement, can leave patients feeling that they are simply “waiting to die” (which, in truth, they are), and wishing for the oblivion of either coma or death.
As an aside, I read a report from a pain specialist a few years ago (I’ll try to hunt up his report, I can’t remember his name offhand) which questioned the wisdom of treating infections likely to lead to a coma state (primarily pneumonia) in cases where the physician was unlikely to be able to relieve the patient’s pain. He viewpoint was that the patients were being cheated out of “nature’s painkiller”, only to face pain and distress which could have been avoided had the acute infection not been treated.
It behooves us to note that intractable pain is not the only cause of suffering for the terminally ill. Other problems to overcome can include:
- nausea
- shortness of breath
- bleeding (eg. from lungs)
- delirium and agitation
- incontinence
- profound weakness
- depression
In my experience/opinion, nausea can be the most vexing symptom to treat successfully.
In any case, those patients who would opt for euthanasia may be having to deal with more than ‘just’ pain.
Thanks Karl - I’ve seen quite a lot of people whose whole world is reduced to just a hospital bed who’ve told me that their pain is only an additional burden, it’s their sheer helplessness and dependence on others to perform the smallest task for them (at the time of the hospital’s rather than the patient’s choosing) , or it’s painless - but otherwise distressing - features of their particular illness which makes their existence unbearable.
I know that GQ is not the place for anecdotes, but I’d like to relate one. A year before my SO’s death he had a particularly nasty dose of crypoccocal meningitis. I held his medical power of attorney. During this time, he was borderline comatose - only capable of responding to stimuli at an instinctive level.
Two incidents stand out in my mind. The first was walking into his room and seeing a nurse trying to give him sips of apple juice - he LOATHED apple juice, but was in no condition to protest if he had any awareness that was what he was being fed.
The second incident was walking into his room and finding his bed totally saturated with urine. When I reported the need for his bedclothes to be changed to the nurse’s station, the sister on duty’s response was “why does he always do this when we’re busy?”. I’ve often wondered how long he would have lain in that wet bed had I not visited at that time.
I should probably also point out that one of the side benefits of using morphine as a pain-killer is that it can also relieve the distress of breathlessness, even though it doesn’t actually improve saturated oxygen levels.
I been given narcotics twice; both times my pain was not relieved to any extent. All I did was throw up. So, what is available for me that doesn’t make me unable to function? Speaking of pain, since I can’t take NSAIDS, I have no good everyday pain reliever. Asprin doesn’t work (since I was a child) and although Tylenol is all right sometimes, it is nowhere as effective as an NSAID. I suppose pharmaceutical companies aren’t motivated in this direction since NSAIDS are so great at relieving pain for most people. I’m 60 so sometimes I worry about this. I guess I’d better stay healthy.