The need for pain relief varies widely, depending on the severity of the pain and whether it's temporary or chronic. While many people have concerns about the addictive nature of pain relief, it's important to think about what this means when someone is already close to the end of their life.

Pain Relief [transcript]

[00:00:00] Let's talk a little bit about pain and pain relief. 

[00:00:06] First, it's a good thing to keep in mind that there are different kinds of pain. Some pain is acute and temporary, and it's the consequence of an injury or an illness that you're expected to recover from. Pain relief in this situation is focused on helping that recovery, and it's expected to be temporary.

[00:00:28] Some pain, however, is chronic and it can last for months or years. Pain relief in that situation is focused on managing the pain. Maybe total relief, but more likely just on a marginal amount of relief, creating sufficient amounts of relief so that somebody can return to their activities of daily living. Even if it has to be modified, sometimes that's all that we can hope for when somebody is dealing with pretty severe chronic pain. 

[00:01:00] The consequences of pain and the reason why we actually focus so much on it — I mean, we all have experienced pain, I'm sure, and we just know that it's really hard — but if somebody is actually experiencing particularly acute, chronic pain (Or just, you know, just chronic pain. It doesn't even have to be acute. It just has to be ever present.) it can cause people to be depressed and to feel isolated. You know, having pain that interrupts the things that you used to do — all the things that affect your identity, being able to move around in the world, do hobbies, you know, interact with friends without constantly feeling this pain — that can actually change your life in a pretty big way, and it can cause some pretty severe isolation. It can also mean that you'll miss work, which will result in reduced income. And that kind of compensating for pain can actually create increased disability, a cascade of symptoms, other things that are caused as a result of inactivity or modified activity as a result of, uh, responding to chronic pain.

[00:02:07] And that's something that's pretty significant. And so of course we always wanna talk about relief. 

[00:02:14] Now, one thing that comes up a lot, especially these days, is talking about abuse of pain relief medicines. Most pains are treated with medicines and they do carry with them a risk of addiction or abuse, particularly with opioids. And as we all know, there's a pretty significant opioid crisis happening right now, and so it's definitely something to think about. It's something that comes up a lot where medical doctors in particular are concerned about over-prescribing opioids, especially for somebody who has chronic pain, and they want to make sure that they're, you know, not contributing to somebody experiencing an addiction.

[00:03:00] Now, that's something that is relevant when you're treating patients that have a hope for recovery. You know, that's something that's important to keep in mind. But when somebody is actually actively dying, then maybe that concern for addiction is misplaced. It doesn't matter. You know, we are not necessarily concerned about extending the length of their life if they're already dying. So it can be a kindness to focus on comfort at the end of life instead, and not be so concerned about addiction that you actually deny somebody the necessary pain relief that can come from medicines like opioids.

[00:03:37] Another thing that's been coming up recently is the use of THC, which is the active ingredient in marijuana, as a pain relief. Now, it's being actively studied and the results have been mixed, but it's generally really positive. 

[00:03:54] The way that pain works is we're experiencing it as a result of nerves sending signals to the brain that something in our body is painful. THC tends to blunt the signal getting to the brain so that we don't actually experience that kind of pain. And that's the main reason that THC is super useful because it blunts the signal process and so we are no longer experiencing the pain. Some people have found that THC is really, really effective for pain and sometimes the only thing that's effective for pain and and nausea, particularly with cancer treatments.

[00:04:31] So this is something that's in active study and if you've got it available to you or you can talk with your doctor about it, I would recommend, uh, talking about it. And this is one of the main reasons that THC is being legalized in different places because of its medical applications. 

[00:04:51] Another thing that people have found that's extremely useful is to go beyond medicine and to look at mindfulness as a form of pain relief. Especially for people who are dealing with chronic pain and who want to avoid the addictive nature of opioids or that have not found that those things are particularly effective, then they can turn to mindfulness as another form of pain relief. And it's been shown in many studies for many years that it can be quite effective, especially for managing chronic pain. Now, one thing to note is that mindfulness has to be actively chosen by the patient and regularly practiced in order to be effective. It's not instant, but it can be something that is more long lasting and less addictive than opioids and causing less of a crisis, and in general actually have positive impacts on all different parts of somebody's life.

[00:05:47] So talking about pain relief, what you will and won't tolerate, what you do and don't want as a result of pain relief, is actually really important. 

[00:05:57] One of the other things to keep in mind and to talk about with your doctor or with your healthcare agent is the fact that the idea of relief from pain has degrees. Often when we are taking pain medication in particular or THC, it can actually interfere with our ability to stay alert and engaged. We become less aware of our surroundings. We become less aware of time or of the people around us. And so, you don't necessarily wanna say like, "I don't wanna feel any pain at all," because that is a recipe for requesting complete, like mental obliteration, you know, you just wanna be completely out of it and that's the only way to feel no pain. So sometimes you wanna actually invite modulating the amount of relief that you're gonna be getting, and balancing it against how aware you wanna stay about your surroundings. So you can do this by either having less pain relief and so that you'll still feel some pain, but it's not as sharp, or by saying like, "well, I want pain relief to be total when I'm trying to sleep, but I wanna be awake for the times that I've got visitors," or something like that. 

[00:07:05] So think about how you actually want to be experiencing pain relief and know that it actually can come in degrees. It's really okay, and it's actually great to be able to specify with people and have conversations about the types and the amount of pain relief that you want and the things that you actually want out of it. Make this an active conversation. It's not one and done. You don't say like, "oh, this is my desire for pain, really for all time," because pain can actually change levels and types and locations. 

[00:07:36] So, make sure that you are talking to somebody who is willing to listen about the kinds of pain relief that you want, the kinds of experience that you want to have, so that they could take that into consideration when they have to make decisions on your behalf about the kinds of pain relief that you might need to have if you are suffering and unable to speak for yourself.