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LIFE BEFORE DEATH -- The Ripple Effect

Posted by Greg Schneider on November 6, 2011 at 10:43am
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Tags: "pain management", pain, policy, regulation, "ripple effect"
Ripple Effect Short film 23 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing effect palliative care services can deliver to patients and their families around the world. In this short film we discover the very real and dangerous consequences of untreated pain. "As a society we don't need to have bad deaths because that's inhumane," reflects Dr David Morrison (Canada). "But they do occur and the residual effect of a bad death on a family is really difficult. To allow somebody to die in pain, when it's not necessary, that's a tragedy." "If one man in a family suffers agonizing pain, it's the whole family that suffers from it," explains Dr MR Rajagopal (India). "Everything in the family is now concentrated on relieving that person's suffering." "If you don't treat pain, patients can't live their day-to-day lives -- they can't go to work -- and if they're the main breadwinners in the family and they're not able to do that well... many things can go wrong," considers Dr Zipporah Ali (Kenya). "People don't go to work. It destroys families," states Mary Callaway (USA). "Think about the amount of money that would be saved in the workforce and how much better off families and relationships would be if they weren't impacted by untreated pain." "The consequences of course, sometimes unfortunately, will be the destruction of the family socially," continues Dr Rajagopal. "The children's education stops. The family's cow is sold first. Then the home is lost. And everything is sold so they can relieve this man's suffering." "We have clear evidence in developed countries that untreated pain has actually a cost impact on society," reveals Dr Jim Cleary (Australia). "To me the critical issue, the cost of pain, is the personal suffering that it inflicts." "We have the means to treat pain," states Dr Mary Cardosa (Malaysia). "We have the drugs, we have the techniques, so it's actually needless suffering." "A month back I treated a man -- not with cancer, with a painful muscular disease -- he came to us and he had this large black scar around his neck," recalls Dr Rajagopal. "The pain was so intolerable that he tried to hang himself and his two children, around 12 and 8, saw this, came running, lifted him up -- thereby keeping him alive. How much scars will there be on those two kids?" "Suffering from severe cancer pain, or pain related to HIV, can be really extreme," concludes Diederik Lohman (The Netherlands). "We've had multiple people tell us that they would prefer to die rather than to have to face the pain that they were suffering. On top of that pain can be treated with very inexpensive medications that are generally not very hard to administer. So there's really no reason why any patient should have to suffer pain. We have the medications, we have the knowledge, it's not difficult for doctors or nurses to treat pain and yet in many countries pain treatment is very poorly available and millions of people suffer."

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  • Frances Shani Parker November 6, 2011 at 11:12pm

    Greg, thank you for reminding everyone again of how critical the issue of pain management is, particularly at the global level.

    Regarding pain management in America, I have concluded from my own observations and readings that the success of pain management depends on the context in which it is given, including with hospice care. The certainty of hospice care providing a pain-free, end-of-life experience is increased significantly when several safeguards are in place:


    1) Appropriate pain medication and management procedures must be prescribed by a doctor with expertise in this area. Really listening to feedback of patients regarding their pain is crucial. Patients need others to advocate for them when their pain is under treated. 

    2) Medical personnel must be knowledgeable in how to implement appropriate pain management procedures that the doctor prescribes. This includes informing CNA’s (nurse assistants) of their roles related to the hospice philosophy and pain management. Like any other important procedure, pain management requires ongoing monitoring and adjustment, particularly when staff attendance and schedules are irregular. 

    3) Attitudes of everyone, including doctors, regarding how pain is being treated must be explored honestly. Disparities continue to be documented. Staff education on transitioning from a total focus on cure to one of non-curative quality of life must also be addressed. In addition, some families need help in understanding that chronic severe pain is not a necessary part of dying. More emphasis on pain management of patients with dementia and others who may not be able to convey their degree of pain verbally must be explored. Ultimately, everyone involved in hospice care must be committed to pain-free death journeys.

    Frances Shani Parker

    From Hospice and Nursing Homes Blog

    http://hospiceandnursinghomes.blogspot.com/

  • Greg Schneider November 6, 2011 at 10:49am
    "As a society we don't need to have bad deaths because that's inhumane," reflects Dr David Morrison (Canada). "But they do occur and the residual effect of a bad death on a family is really difficult. To allow somebody to die in pain, when it's not necessary, that's a tragedy."
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