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Myth: Increased Doses of Painkillers Cause Death

By Jennifer B. Buckley

Many professional and family caregivers deem increasing the amount of prescription pain medication, for chronically ill people in pain, an unacceptable act. Terminally ill people are literally dying with an unnecessary amount of pain because of the negative stigma attached to administering surplus pain-killing opioids when needed. Many family caregivers and medical personnel are under the notion that upping doses of painkillers can be fatal. In addition, some believe pain medications like opioids, are a narcotic that is extremely addictive and includes heavy side effects. But, a new survey published in the July 29, 2000 issue of The Lancet suggests, “Increasing use of pain-killing opioids such as morphine in terminally ill patients does not shorten life.”

Researchers reviewed the cases 238 patients who died during palliative care in their institutions. The study was prompted by public and professional concern that the use of opioids for symptom control might shorten life. They retrospectively analyzed the pattern of opioid use in the last week of life; the daily doses were low. However, marked increases in opioids at the end of life did not significantly influence survival, frequency of unexpected death, or description of death. 

The study challenges the myth that proper pain control for end-of-life care means killing the patient. According to Sandra Johnson, former president of the American Society of Law, Medicine and Ethics and expert in the area of health law, pain management and care for the elderly, “The problem is many people believe that pain medication, like opioids, are addictive and have terrible side effects. The fact is, the risk of addiction for someone who is receiving end-of-life care, is irrelevant and side effects aren’t severe and eventually clear up.” Some of the side effects attributed to opioids include constipation, blurred vision and lethargy and eventually, a person’s body will become acclimated to them. 

Part of the problem in nursing and medical education is that much of the research on the effectiveness and safety of pain management is relatively recent and contradicts common knowledge of earlier pain control practices. Some professionals in the medical community think proper palliative or comfort care is euthanasia under a different name. In the Lancet report, Drs. Andrew Thorns and Nigel Sykes of St. Christopher’s hospicee in London said, “There is no connection between competent symptom control and euthanasia. It is possible to achieve good symptom control by using morphine competently, and you do not shorten people’s lives when you do that.” Also, physicians feel threatened by legal sanctions for treating patients in pain especially when the treatment relies on the use of controlled substances. The report recommends that if a doctor is seriously concerned about shortening a patient’s life, they should consult a specialist in the field of palliative care.

Another myth concerning pain control is that over-the-counter pain medications, like ibuprofen, are much safer than opioids. This perception is incorrect and according to Ms. Johnson, “Large doses of ibuprofen are more dangerous and more harmful to the stomach and liver, than we realize. Over-the-counter does not mean safer.” Non-prescription pain relievers should be administered with caution and still may not relieve pain properly. 

Suffering doesn’t have to be a necessary part of death. Ms. Johnson comments, “What we know now about pain management is that, 95% of cancer pain can and should be relieved through simple means, like morphine. In the past we were told not to medicate, that was then and this is now.” She believes that drugs do not hasten death but pain may hasten death.

Through good hard information, like The Lancet report, the perception of treating pain by care professionals and the public could transform. Family caregivers may want to communicate with their doctors their interest in obtaining more information about certain pain medications; because it is possible not all care professionals have read the new research themselves. According to the study, our loved-ones do not have to spend the last days of their lives in pain any more.

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