P AIN MANAGEMENT

Pain management concerns how the students address the issue of pain in the patient.

This area corresponds with the area of symptom management and deals with how the students have to be able to pick up on the patients’ cues in regards to pain and act on a basis of this. Different aspects of pain management are mentioned, and

subcategories are the following:

• Theory on physiology and pain therapy in general

• Medicamental pain therapy

• Non-medicamental pain therapy

• Observational skills

• Ethics

It has been underlined by the respondents that the concept of pain also includes other forms of pain than the physical one, and that psychological and spiritual issues also are relevant to pain and can actually be the cause of physical pain. However, these psychological issues are discussed in the area of mental health issues, and this chapter is limited to the issue of physical pain.

4.4.1 Theory on physiology and pain therapy in general

”Understanding of pain - different types of pain and different types of pain relieving”.

To understand the patients’ pain and address this issue, the students need to obtain general knowledge about the concept of pain. There are different aspects of pain that are essential to have knowledge about. One important area is the physiology behind the pain, to understand anatomy, physiology and the nervous system and what makes the body experience pain. The students also need understanding of the fact that there are different types of pain, for instance acute pain as opposed to chronic pain or cancer related pain, like metastasis into the skeleton.

”Understanding of pain - different types of pain and different types of pain relieving”.

They also need to understand what kind of pain therapy is necessary in different cases.

”Knowledge on pain therapy – what kind of therapy is available, and where to turn to if help is needed”.

How to interpret signs of pain in the patient when the patient no longer can verbally express pain is important. Also to understand that there are differences in the patients’

pain threshold and that pain is an individual experience that requires individual treatment. The students need to understand the consequences of being exposed to pain on a long-term basis and how pain can have an effect on the entire body, even though only one part of the body is directly affected.

4.4.2 Medicamental pain therapy

Medicamental pain therapy is a profound part of the palliative care treatment, and it is essential that the students have a thorough training in how to handle medications.

Basic pharmacology is a starting point and an area that need to be explored by the students. They have to know what kind of medication is necessary for what kind of pain, how the medication affect the body in terms of working mechanism and side effects.

”Knowledge on how different types of medication works, and possible side effects”.

The students need knowledge of the different types of medication and the names and normal dosage of the most common drugs. Calculation is also a necessary skill when administering medication.

”How to administer pain medications and knowledge on the most common medications and dosages”.

A number of different ways of administering medications are available, and the students need training in how to do this. Tablets, capsules, injections, infusions and analgesia pumps are mentioned as the most common ways of administering

medication. The respondents underlined that medication in palliative care patients is different from most other patient groups, as the goal only is to relieve the patient from pain, without taking into consideration the possible addiction to strong drugs.

Another subject mentioned by the respondents is how to identify in the patient when the medication dosage needs adjustments as pain increases.

4.4.3 Non-medicamental pain therapy

An important issue in pain therapy is the use of non-medicamental measures, often referred to as complementary pain therapy.

”Non-medicamental pain relieving strategies – conversations, soothing environment, massages, skin care, treatment of wounds, meditation, water therapy, light

treatment”.

The importance of this is highly emphasized by the respondents, and several different actions are described. I will mention all of them briefly: Massages, physical contact, anxiety restraining techniques, music, closeness to the patient, calming surroundings, changing of the patients position, safety, light treatment, water therapy, skin care, relaxation techniques, heat, and guided imaginary.

The main emphasis is concerning the students’ awareness of the fact that medication in itself is not enough, and that non-medicamental pain therapy is part of a holistic way of viewing the patient.

4.4.4 Observation

Observation skills are essential in all aspects of caring for palliative patients, but are mentioned the most frequently in regards to pain.

”How to be able to recognize when the patient is in pain”

How to observe symptoms of pain is of great importance, and the students have to interpret the patients’ cues and be able to act on it. This is especially important when the patient no longer can express their potential pain verbally.

”How to interpret signs of pain when the patient have lost their ability to communicate verbally”.

According to the respondents, symptoms of pain and symptoms of anxiety might be similar, and difficult to interpret. To make an effort in picking up on the patients’

cues is vital, as there are quite different measures for how the students should address pain as opposed to anxiety.

4.4.5 Ethics

Ethics about pain relieving therapy is an issue to the respondents. There is a dilemma between allowing the patient to be relieved of pain, and being totally sedated and not able to communicate in the last phase in life. This has to do with quality of life, even in the last stage of life. The patients’ autonomy has to be respected in these cases.

”Sedation of dying patients. Considerations of ethics and the autonomy of the patient in these situations”.