Pain Management of the Terminally Ill

Pain Management

Proponents of "choice' in dying exploit and foster fear of pain in order to further their drive to legalize physician-assisted suicide. But the reality is that no one should have to make the awful choice between intolerable pain and suicide. We are not awaiting some scientific breakthrough with which to conquer pain. There is already available a vast array of means to help patients live free of pain. Advances in pain management in recent years include new drugs, self-administered morphine pumps, epidural catheters, biofeedback, adaptive devices, and even clinics established specifically to treat pain.

In spite of the many benefits of good pain relief - such as patient well-being, medical cost savings, and less lost time from work - and in spite of the modern arsenal of weapons against pain, many patients live their last weeks and months in severe discomfort or pain. This can - and must - be changed!

One positive outcome of the discussion about physician-assisted suicide is that doctors, nurses, and the public are learning more about proper assessment and treatment of pain. Good pain management is a reality, but it requires dedication and time. Patients in pain and their families should insist that every effort be made to control pain, including consulatation with a hospice physician/pharmacist or a referral to a pain management clinic if necessary. If a physician does not have the knowledge, compassion or time necessary to assess and treat pain effectively, the patient should seek another doctor!
Researchers studying American cancer patients discovered that those who were actually in pain were more likely to reject the notion of physician-assisted suicide and euthanasia than those who anticipate or fear pain. Researchers concluded that patients who are actually confronting the problem are more interested in getting rid of their pain than in dying (Lancet, 6/29/96:1805-1810).

Sometimes, an unintended side effect of massive painkillers is to shorten life, e.g., large amounts of morphine may suppress respiration. But the intent is to alleviate pain and not to cause or hasten death. This is sometimes referred to as the principle of "double effect"; most ethicists agree that this is not euthanasia. Doctors know the difference between killing pain and killing a patient - and should be held accountable.

Pain is generally categorized in six different areas:

* Joint and Muscle Pain, which accounts for the majority of patients attending pain clinics.
 * Causalgia (ko-zal-je-a), which is the burning pain that follows a bullet wound or some other sudden shock to the nervous system. This type of pain is likely to go away within a few months, but in some cases, it could continue for years.
 * Neuralgia (noo-ral-je-a), which originates in the peripheral nerves is triggered by cold air, chewing or stress.
 * Phantom limb pain, which may originate sometime after an amputation is a mild sensation of "pins and needles" that turn into shooting pains that continue for years.
* Vascular pain is associated with dilated blood vessels around the brain that cause migraine headaches.
* Cancer pain is the result of destruction of tissue or blockage of major organs by a growing tumor, or spread of certain cancers that reach the spine and press on nerves.

Some of the methods used to relieve various kinds of pain include: the use of narcotics and other medications; psychiatry; exercise; acupuncture; surgery; meditation; and chiropractics.

Pain management is now considered a medical specialty. Unfortunately, many health care professionals have received little or no training in the art of relieving pain. Several national organizations offer education to patients, families, and physicians about the provision of better pain relief.

For more information see the American Academy for Pain Management web site:

Source: Right to Life of Greater Cincinnati, Inc.; 

Catholic Guide to End-of-Life Decisions

Catholic Guide to End-of-Life Decisions, including an explanation of Church teaching on advance directives, euthanasia, and physician assisted suicide has been made available by the National Catholic Bioethic Center at: