Understanding the Distinctions Between Palliative Care and Hospice
Hospice care and palliative care are often used interchangeably causing people to assume they are the same. If not being used interchangeably, many people assume palliative care is only given in conjunction with hospice care, but in fact, palliative care can be given separately. Hospice is simply a type of palliative care.
This mistake can prevent people from using palliative care who could otherwise benefit. As we well know, chronic pain can come from a variety of sources. Some chronic pain is caused by a non-life-threatening, acute event, while other pain is attached to a terminal illness. Chronic pain can alter a person’s lifestyle, functional ability, and sometimes even personality.
According to the NIH, there are three groups of patients who have a need for palliative care, “those who have a palliative period of advancing progressive disease; those who have a stable or no disease, relatively few symptoms but then deteriorate or die suddenly; and those who suffer from chronic disease, where the disease is not clearly progressing, but who might have periods of progression and symptoms where they would benefit from palliative care and then periods of remission.”
Hospice vs. Palliative Care
Hospice care is for patients who are no longer receiving curative treatments. Hospice is chosen when treatments are no longer working or that the negative treatment experience outweighs the benefit of prolonging life with the treatments.
Removing treatment often improves the quality of life, which is the goal. On the other hand, palliative care does not require people to forego curative treatment if they are suffering from a chronic, progressive, or advanced illness.
Palliative care is simply pain management. It should be thought of as symptom control and is intended to ease any pain associated with a disease, medical condition, or illness. Ideally, a person could receive palliative care from diagnosis until death regardless of how long that period lasts. Hospice, however, is normally intended for the last six months of a person’s life.
Types of Pain Management
Since pain is highly subjective, treatment changes from person to person. In addition to physical pain, there is also the potential for psychological, spiritual, and social pain, which palliative care attempts to address. There are different ways in which palliative care teams attempt to alleviate pain:
Pharmacological methods
The World Health Organization created what is called a pain ladder as a guideline for pain management. It defines how doctors should manage pain and is useful for patients to know as well.
Pain management should begin with nonopioid medications like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and gradually progress towards more potent non-painkiller methods like nerve blocks or epidurals.
Sometimes, anti-depressants and muscle relaxers can be useful before treating with opioids. Only after all these options are exhausted should opioids be used due to the high risk of addiction. Of course, for people with terminal illnesses or at the end stage of a disease, immediate opioid therapy is usually required, and the risk of addiction is not as important.
Opioids works because they attach to receptors found in the brain and nervous system, reducing the incoming signals of pain. Initially found naturally in the poppy plant, most opioids are synthetically produced and, as such, are much stronger than their naturally occurring counterpart. The issue with long term use not only lies with addiction, but the body eventually grows a tolerance, and stronger medications must be used as treatment progresses.
Non-pharmacological methods
Depending on where the pain originates from and how debilitating the disease has become, sometimes no medication is needed. Non-pharmacological pain management methods include physical therapy, yoga, mind-body practices like Tai Chi, behavioral therapy, and meditation.
With most conditions, exercise is recommended as a first step in managing pain. A few interesting types of non-pharmacological treatments are as follows:
Transcutaneous Electrical Nerve Stimulation (TENs)
Studies have shown that TENs are not useful for all pain, specifically cancer pain, but have yielded positive results in some patients. The theory behind TENs is that the electric current stimulated nerves, which in turn block pain signals from reaching the brain. This doesn’t get rid of the pain but changes how the body reacts to the pain. Likewise, the electric stimulation also produces endorphins that are the body’s natural painkiller.
Acupuncture
Acupuncture has been practiced for thousands of years, but it hasn’t been until the 1970s that it gained popularity in Western culture. Similar to above, acupuncture’s success depends on the type of pain a person is experiencing. Practitioners believe that acupuncture activates the body’s self-healing mechanisms, thus reducing pain for the long term with regular acupuncture sessions. It is not a magical cure-all, but it can be very beneficial with other types of pain management strategies.
Acupuncture Can Help with Chronic Relief Pain Even at End of Life
Acupuncture, an ancient Chinese practice, is increasingly being recognized in Western medicine as an effective treatment for chronic pain. In fact, many studies are entering a master's and doctoral acupuncture program, which is available in many universities.
It involves the insertion of thin needles at specific points on the body, aiming to balance the body's energy, or "qi." Research shows that this method stimulates the body's natural painkillers, endorphins, thus relieving people suffering from osteoarthritis, migraines, and lower back pain. Many of these health problems become more chronic as people age.
More medical professionals are now recommending acupuncture as a complementary treatment, offering an alternative to those seeking non-pharmacological treatment for managing their chronic pain.
Music Therapy
Music therapy has gained popularity for chronic pain management in recent years. It provides stimulation that evokes an overall mood change and reduces the amount of pain a person perceives. It helps with relaxation, rhythmic breathing, and meditation as well.
When Is Palliative Care Appropriate?
For many people, it can be hard to judge if palliative care is right for their situation. Generally, with a progressive illness, such as terminal cancer, it’s usually clear when it is time to discontinue curative treatment and focus mainly on comfort. The person’s condition would have declined for some time and their ability to function independently would be a major challenge.
However, with a chronic condition or for someone with many medical conditions but no terminal diagnosis, it can be harder to decide when to use palliative care. For chronic conditions, setbacks and complications can happen throughout but are frequently treated and reversed– leading people to believe they do not need palliative care.
Even with improvements and reversals, though, palliative care can still be a part of their complete care, improving quality of life.
Max Gottlieb is the content manager for Senior Planning. Senior Planning provides free assistance to seniors and the disabled, specializing in long-term care.