Strategies for Managing Total Pain in Palliative Care -

Pain is an unpleasant sensory and emotional experience caused by physical damage to the system. It is a common symptom of terminal illnesses and a major challenge for palliative care as often lasts long enough to hamper the patients’ life quality.

But serious/terminal illnesses (like cancer, autoimmune diseases, metabolic dysfunction, neurodegenerative diseases, etc.) can severely disrupt a person’s life on levels beyond the physical.

Dame Cicely Saunders, an English nurse, physician, and founder of the modern hospice movement, described ‘total pain’ as the total physical, psychological, social, and spiritual struggle of a person.

This definition is based on how her patients expressed their experiences, leading her to derive that an individual’s pain is a whole overwhelming occurrence, and not limited to physiology. It is a product of various sensory and affective factors together, resulting in severe suffering/struggles for the patient.

For instance, as the illness worsens, the family’s sense of helplessness causes them to not visit the patient as often. Thus, for the patient, the physical pain further manifests into psychological pain from this sense of abandonment.

Components Of Total Pain

Total pain has four components:

Physical pain

This can be due to pre-existing illnesses, tissue injury, treatment side effects, or chronic conditions. This leads to impaired function and lifestyle. Patients also isolate themselves socially from the fear of worsening the pain.

Psychological pain

It can manifest as anxiety, depression, fear of suffering, past illness experiences, and hopelessness/helplessness due to medical uncertainty.

Social pain

This involves factors like loss of job/social status, financial concerns due to high medical expenses and inability to work and earn, loss of role as the family’s provider, lack of dignity and self-worth, fear of dependency on the family, and worries about the family’s future.

Spiritual pain

It exhibits as anger at fate/God, loss of faith, existential crisis, seeing life as purposeless, questioning life’s meaning and the dying process – “Why me?”, fear of the unknown, feeling of disconnection and abandonment, etc.

Strategies To Manage Total Pain

Clinicians tend to focus only on the patient’s physical pain component with conventional analgesics and overlook the effects of life-limiting illnesses on one’s spiritual, social, and psychological domains. No one person or discipline can fully address total pain.

As a result, interdisciplinary teams (IDTs) are essential for alleviating this condition and addressing the expectations regarding future quality of life. Listening to the patient’s ailment narrative in a careful and unhurried manner is vital for assessing all four domains of total pain.

Elisabeth Kubler-Ross, a Swiss American psychiatrist and a pioneer in near-death studies has emphasized that dying patients yearn for communication, touch, and love. Hence, besides conventional pharmacotherapies and interventional painkillers, it is essential to sit with them, listen to what they say, and give them much-needed attention and company.

Little gestures like holding hands can also help in enabling care for total pain. It is also important to facilitate a conversation between the patients and caregivers to find appropriate solutions for the patient’s changing family role and medical status.

Involving people like social workers, priests, psychologists, etc., can help explore the patient’s spiritual pain sprouting from life’s perceived meaninglessness and fear of death.

Ayurveda For Total Pain in Palliative Care

The science of Ayurveda has always emphasized holistic healthcare and well-being. It provides detailed guidelines and principles for comprehensive treatment that can ease the emotional, social, physical, mental, and spiritual concerns of the patients.

The first focus is on maintaining the patient’s nutrition with appropriate dietary and lifestyle modifications to cater to the drastically changing requirements of the system and strengthen the body’s digestion and metabolism. Ayurveda stresses the consumption of foods that are not only palatable and easy to digest but also nutritive.

This can help improve the effectiveness of the ongoing treatment, minimize any adverse effects, and refine the body’s physiology for better life quality. Some of the recommended food preparations can include medicinal plants as well, to aid the treatment.

The right Ayurvedic interventions can provide a critical support system to patients undergoing traditional treatment regimens and therapies (chemotherapy/radiotherapy). They include:

Abhyanga: Massage with warm medicated oils to help reduce stress and muscle stiffness, increase energy and physical strength, and promote overall wellness.
Swedana: A therapy that uses heat and induces sweating to cleanse the body of accumulated toxins, promote better absorption of medicinal substances, and rejuvenate the mind.
Shirodhara: An ancient purifying and rejuvenating therapy that enhances the functions of the central nervous system and helps relieve stress, mental exhaustion, and other psychological concerns.
Rasayan: This therapy leverages various herbs and minerals to improve health, function, and vitality. It further reduces stress and anxiety levels, enhances immune function and digestion, and promotes circulation and regeneration in the system.
Yoga and Meditation: Pranayama, and relaxing yoga postures can not only address the spiritual aspects of total pain but also alleviate emotional and psychological concerns like anxiety and depression. Practices like ‘mindful yoga’ and ‘yoga nidra’ can be effective therapies for palliative care and empowering patients in all dimensions.

Vijaya For Total Pain in Palliative Care

Ayurvedic doctors strictly prohibit the use of traditional painkillers like opioids because they exhibit severe side effects on the system, which can be life-threatening as well. They also have a high risk of dependence, overdose, and even death. Instead, they prescribe the valuable ayurvedic herb Vijaya, due to its incredible efficacy and high safety profile.

As per a survey, nearly 50% of oncologists recommended Vijaya-based medications clinically for palliative care. Additionally, 67% found it to be an effective alternative to standard pain management strategies, and 65% viewed the herb to be more effective than the conventional treatments for conditions like anorexia and cachexia, some of the most common symptoms faced by terminally ill patients.

Studies have further indicated that Vijaya can effectively reduce pain associated with terminal conditions like cancer and do so without showing any adverse side effects. This herb is well-tolerated by patients, unlike the harmful and addictive analgesics.

Vijaya can also help ease feelings of anxiety and stress. A 2023 research showed that among the patients consuming Vijaya-based medications for neurological disorders-

96% saw a reduction in their symptoms.
88% found a better ability to perform their professional duties.
79% saw improved sleep quality.
71% had better appetite.
68% felt increased energy and vitality.

This shows that Vijaya is not only revered for its efficacy in chronic pain relief but is also helpful for upgrading the quality of life among patients safely and holistically. As a result, medical practitioners and ayurvedic experts increasingly recommend this vital herb in aiding end-of-life care.

Contact Hempstreet to know more about leveraging the holistic benefits of Ayurveda for managing total pain in palliative care.