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Managing Bone and Joint Health During Hospice

Pain in the bones and joints is common in the final stages of life, especially if the patient suffers from bone cancer or osteoporosis. Just lying in bed for prolonged periods of time can cause pressure on the bones and joints, making bone and joint pain very uncomfortable for those in hospice in San Mateo and elsewhere. October 12 through 20 was Bone and Joint Action Week, held annually with activities focused on disorders including back pain, arthritis, trauma, and osteoporosis. This annual weekly designation was created to raise awareness about prevention, treatment, and disease management.

Bone and Joint Health Facts

According to the Bone and Joint Initiative:

  • 54% of Americans over the age of 18 suffer from musculoskeletal (bone and joint) conditions.
  • 33% (one in three) people over the age of 18 received medical care for a musculoskeletal condition from 2009 to 2011, which represents a 19% increase over the last 10 years.
  • Bone and joint conditions happen to be the most common cause of severe long-term pain and physical disability around the world, impacting hundreds of millions of people.
  • Musculoskeletal conditions include arthritis, back pain, trauma, spinal deformity, osteoporosis, and childhood conditions.
  • Musculoskeletal conditions are predicted to increase because of life expectancy and risk factors unless and until new treatments are revealed.
  • Musculoskeletal conditions can result in significant disability as well as lower productivity and quality of life.
  • Research funding is less than two percent of the National Institutes of Health’s annual budget, continuing to decline each year despite the higher costs associated with back pain, injuries and arthritis.

The five days of Bone and Joint Action Week include:

  • October 12 – World Arthritis Day
  • October 16 – World Spine Day
  • October 17 – World Trauma Day
  • October 19 – World Pediatric Bone and Joint (PB&J) Day
  • October 20 – World Osteoporosis Day

Managing Pain

By using the right type of pain management, most bone and joint pain problems can either be relieved or reduced. The first step in managing pain in hospice is to perform a total pain assessment, says Johns Hopkins Medicine. You will be asked to choose a number from 0 to 10 as a way to rank your pain, with 0 being extremely mild pain and 10 being the worst pain you could imagine.

There are three important principles involved in how to manage pain.

#1: Pain should be treated right away, as delays allow pain to worsen.

#2: Don’t be afraid of getting addicted to pain medicine. When used in the right way under proper supervision of a healthcare provider, problems rarely occur.

#3: Most bone and joint pain can be controlled by using this approach:

  • Start with a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen.
  • If pain continues or worsens, a weaker opioid medicine, like hydrocodone, may be prescribed. This may be combined with a non-opioid pain reliever.
  • If pain still continues or worsens, a stronger opiate may be prescribed, such as morphine and fentanyl.

Opioid drugs are the most common and effective drugs for moderate to severe pain related to bone and joint pain. A wide spectrum of opioid drugs is available, with the ability to be taken in many ways. One drawback to these meds is that you will likely develop a tolerance to the one you’re on and will need higher and higher doses as your time in hospice goes on, in order to achieve the same effect. Your healthcare provider can switch up your dose, medication type, or the way the drug is being given to you.

Many kinds of pain medicines can be used to treat bone cancer pain, in particular, such as through pills, patches, and pumps that allow you to dispense the medicine into your body when needed points out the American Cancer Society. Those methods include:

  • Oral medicines, in pill or liquid form
  • Adhesive patch, applied to the skin to periodically release medicine
  • Opioid drug injection, given under the skin or into your muscle
  • Opioid drug IV, given directly into the blood via an intravenous line
  • Medicine pump attached to an IV line that the patient controls
  • Spinal injection, given directly into the area of the spinal cord

So-called “helper” medicines, AKA adjuvant analgesics, can be given in conjunction with the above to help control pain, such as:

  • Steroids, which relieve pain by decreasing inflammation
  • Antidepressants, which can treat existing depression or anxiety, thereby making pain easier to control
  • Anticonvulsants for controlling seizures and nerve-related pain
  • Local anesthetics, which block pain signals in the body
  • Muscle relaxants, used alongside pain medicine if pain is being aggravated by tension or muscle spasms
  • Bisphosphonates used to prevent fractures in those whose cancer has spread to the bones

While it is an option, even in hospice, surgery is often the last thing patients or their healthcare providers want to consider at end of life. But it may provide pain relief and increase function in extreme cases.

Contact Pathways Home Health and Hospice

Your hospice care team puts your comfort first and will address your bone and joint pain in the best way possible for increased comfort and better quality of life in hospice. To learn more, contact us at 888-978-1306.