Non-invasive pain control in the terminally ill patient

Abstract

Although terminal patients with chronic pain are best managed with oral analgesia, patients who cannot take oral medication of ten receive treatment liy parenteral routes. Seventy consecutive terminal patients admitted to our hospice inpatient facility were evaluatedfor pain control over a three day period. Level ofpain was evaluated on a scale of zero to three (0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain). Patients were also evaluated for level of consciousness on a scale of one to four (1=alert, 2=confused, 3=semi-comatose, 4=comatose). Patients were medicated with morphine sulfate, either orally or by suppository, on a regular, four-hour schedule. Level of pain and level ofconsciousness evaluations were performed at the time each dose of morphine sulfate was administered. Data were compared for the level of pain and level of consciousness for the three day study period using Chisquared analysis. The results showed a significant decrease in levelofpain over the study period (p<.005). During this time, no significant alteration in level of consciousness was noted. Thirtynine out of 65 patients were treated via the suppository route and a significant decrease in the level of pain was seen in this sub-group as well (p<.005). Median morphine sulfate dose in all patients on day three was 15 mg. every four hours, with no significant difference between oral and suppository sub-groups. Parenteral analgesia was not required by any patient to achieve adequate pain control. This study demonstrates that effective pain control in terminal patients can be achieved withoutparenteral administration of analgesia and without alteration in level of consciousness. In patients unable to receive oral analgesia, the use of suppository analgesia is an effective alternative, avoiding the increased discomfort associated with parenteral analgesia administration.