Barbara is an internationally recognized author, speaker, thought leader, and expert on end-of-life care and the dynamics of dying.
It is our honor to welcome Barbara Karnes, RN, to our blog! Barbara is an internationally recognized author, speaker, thought leader, and expert on end-of-life care and the dynamics of dying.
Last month we asked you to send Barbara your questions about death and dying. Here’s the first question, along with Barbara’s insightful answer.
Barbara, can you please talk about end-of-life pain management? Is it painful to die?
Barbara Says: There is so much confusion around pain and the need for pain management at the end-of-life. There is confusion regarding the use of narcotics and confusion about how the body experiences pain as death approaches. This confusion is in the minds of families and the patient. It can also be found in physicians who prescribe narcotic medications and the nursing staff who administer them.
How does the body experience pain at the end of life?
As death approaches, it will look to us, the watchers, as if the person is suffering or feels uncomfortable. We see and hear restlessness, agitation, rattly-sounding breath, moaning, murmuring, discoloration of the skin, and cold hands and feet. We, the watchers, tend to interpret what we see as pain.
But mercifully, in the days and hours leading up to death, the dying person will not experience their physical bodies in the same manner as a healthy person. It’s almost as if the dying person is shedding the physical body. As death approaches, physical sensations (such as pain) are not felt the same way they would be if the person were not dying.
Is it painful to die?
Dying is not painful. Disease causes pain. While many diseases that lead to death do cause pain, many others have no pain in the journey at all. That’s why we can’t assume that everyone who is dying is in pain. It’s critical to look at the person’s disease history to evaluate pain status. Then, treat the disease, not the dying.
When and how much pain medication is appropriate?
For patients with a history of physical pain, we must treat the pain until their last breath, even after becoming unresponsive. A common misconception about pain is that it goes away once the person becomes unresponsive. But, keep in mind, whatever was causing the pain is still in the body.
Over time a person’s tolerance to pain medication may increase, and the dosage will gradually have to be increased. A narcotic administered in small, graduating doses (to address the pain but not exceed the amount of pain present in the body) minimizes the risk of addiction or overdose.
What questions do you have for Barbara?
Do you have a question about end-of-life care or the dying process for Barbara? Send Barbara your question today!