There’s more to palliative care than relieving pain

In this modern age, there is still a seeming widespread misunderstanding of palliative care not only by the public but also by doctors. In most cases, both equate it as an end-of-life care or a hospice.

While it’s true that palliative care does serve many people with life-threatening or terminal illnesses, some people are cured and no longer need palliative care. Others move in and out of palliative care, as needed.

The World Health Organization describes palliative care “as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

Although originally developed for people with terminal illness, palliative care has now become a medical specialty that focuses on a much broader range of serious or life-threatening diseases. In fact, the vast majority of patients who actually need palliative care may not be yet in their terminal stage (are not terminally ill). It is a kind of care that specifically trains a critical eye in balancing between the disease treatment and the comfort of the patient. If, for example, the advantage of comfort far outweighs the cure, the palliative care’s goal is to shift the course of care to that which will benefit the patient most.

Palliative care doctors believe that not only the disease itself causes symptoms, but also the treatments. For example, chemotherapy drugs may cause nausea and vomiting. Also, narcotic drugs to control pain frequently lead to constipation. By providing relief for various symptoms, palliative care can help patients not only carry on with their daily lives, but also improve their ability to undergo or complete their medical treatments.

In a nutshell, all patients suffering from grief and pain deserve palliative care whether they are terminally ill, expected to recover fully, or facing years with debilitating symptoms of a chronic or progressive disease.

Today, most patients with cancer, heart disease, chronic lung disease, AIDS, Alzheimer’s, multiple sclerosis, amyotrophic lateral sclerosis ( ALS), end- stage kidney disease, and many other serious illnesses find palliative care important.

Some of the symptoms that palliative care may address include pain, constipation, nausea and vomiting, diarrhea, bowel or bladder problems, loss of appetite, weight loss, shortness of breath or labored breathing, coughing, depression, delirium or mental confusion weakness, difficulty sleeping, among others.

Palliative care doctors approach begins with what is important to patients as humans, what makes them feel good about themselves, and uses a variety of therapies to relieve the pain, symptoms and stress that accompany serious illnesses. They perform along with the care the patients already receive from their primary doctors.

With palliative care, there is as much effort and attention on relieving pain and other troubling symptoms as meeting the patients emotional, spiritual and practical needs. In short, this medical specialty aims to improve the quality of life however the patients define it for themselves.

One of its strengths is recognition of the human side of illness. In a 2011 survey of palliative care patients, patients mentioned these particular needs: “being recognized as a person,””having a choice and being in control,””being connected to family and the world outside,””being spiritually connected,” and “physical comfort.”

Palliative care may also be a good option if patients have a serious disease that has prompted multiple hospitalizations or emergency room visits during the previous year. If, however, a patient decides to stop pursuing a cure and the primary doctor believes that he is within the last few months of life, he can move to hospice. Palliative care does include the important component of hospice, which gives patient dignity and comfort, but it’s only one part of the larger field.

By providing relief for various symptoms, palliative care can help patients not only to carry on with their daily lives, but also improve their ability to undergo or complete their medical treatments. Moreover, aside from incurring lower medical costs, patients under palliative care have experienced fewer trips to the emergency room or hospital and improved their ability to function and enjoy life. Several studies have shown it has prolonged survival of the terminally ill.

Dr. LUZVIMINDA S. KWONG is Head of the St. Luke’s Pain Management Center in Quezon City. She finished her twoyear fellowship training in Pain Medicine at St. Luke’s Medical Center and visiting fellowship training in Interventional Pain Medicine at the Niagara Health Center and Pain Diagnostics Associates in Wisconsin, USA. She had training and field experience in Hospice & Palliative Care at the Regent’s College & St. Cristopher’s Hospice in London and at Earl Mountbatten Hospice, Isle of Wight, England. Dr. Kwong is the Executive Vice President of the Hospice Philippines, the Board of Trustees member of the Philippine Board of Pain Medicine and the immediate Past President of the Pain Society of the Philippines. For inquiries, please contact the St. Luke’s Pain Management Center in Quezon City at 7230101 ext. 5416 and 4403.