What is “Total Pain”?
Ever had a patient who you felt you had to continually go up and up and up on the pain and anxiety meds? Well…there is a good chance the “pain” is not just physical pain. According to Dame Cicely Saunders, there are multiple facets of pain that can all manifest in the form of physical pain:
1. Psychological (What will death feel like? Will it hurt? Underlying anxiety?
Lack of sleep/rest?)
2. Spiritual (Beliefs in Heaven? Is there an afterlife? Have I done all I can in this Earthly life?)
3. Social (Are my finances in order? Will my family be taken care of? Have I made amends with all family and friends? Who will take over care on my pets, children, work, etc.?)
4. Physical (Actual physical pain? Anticipatory pain?)
Think about it…
You’ve just been told you have 6 months or less to live.
You are currently a working mother of 3 with a mortgage and no will.
How can you ensure that everything is taken care of in such little time?!
I don’t know about you, but just thinking of this makes my heart pound, makes me feel overwhelmed, and I all of sudden feel like there aren’t enough hours in the day and I have a headache! This can absolutely enhance physical pain, just from the lack of sleep, anxiety, and emotional context alone – without even tackling the spiritual aspect.
The glorious thing about hospice is that as the nurse or provider, you are not alone in taking care of this patient’s pain and anxiety! This is the time you pull in the powerful hospice team of chaplains and social workers!
That’s why hospice is a team.
Remember this the next time you are out to visit Ms. Smith for the 4th time that week due to her uncontrolled nausea (despite Zofran 8mg BID), lack of sleep due to anxiety (despite Ativan 4mg ever night), or her nondescript pain not associated with her protein calorie malnutrition (despite escalations all week on her MSER and breakthrough opioids).
It might not be a physical problem.
Phone a friend (i.e. the social worker and/chaplain)! Talk intensely at your interdisciplinary meetings and brainstorm about what each team member knows about the patient – family life, estranged members, financial situation, etc.
As we all know, “pain is what the patient says it is”…but that doesn’t always mean it’s physical pain. Time to dig a little deeper and bring true, meaningful aid to the patient no matter their current physical state.
Jaymie Wilson, APRN-CNP, ACHPN
For more information, check out these resources:
Clark, D. (2014, September 25). ‘Total pain’: the work of Cicely Saunders and the maturing of a concept.
Retrieved from http://endoflifestudies.academicblogs.co.uk/total-pain-the-work-of-cicely-saunders-and-the-maturing-of-a-concept/