Pain at the end of life: relief and shorten the life does not necessarily go hand in hand

Contrary to what is suggested in Article 2 of the draft law on patients' rights and end of life, which allows the doctor to increase the dose of painkillers even though it may result in death, in the majority of cases, palliative care teams can reduce pain in patients without shortening their lives, said Dr. Isabelle Morin, an oncologist in Paris.
This specialist is expressed in a meeting on "New approaches to the treatment of pain", organized by the Hospital Association in 2000, which works to raise the funds needed to finance morphine pumps-the day the Senators were beginning the examination of the draft law on patients' rights and end of life, which was finally adopted.

From a clinical point of view, pain at end of life is "as long chronic pain" but most often the result "of a multiplicity of acute pain" of cutano-muscular, visceral, or neurogenic, by example, "that are superimposed and amplify," she recalled. To relieve these symptoms, without "reduce the patient's pain" and not forgetting "about listening to the suffering" - caregivers use different techniques and medications, including analgesics, including morphine, for relieve severe and very severe pain.

"Morphine does not kill the patient when it is used," insisted the Paris oncologist stating that best practices require the use of opioids including gradual titration. This phase of implementation of treatment is to slowly increase the amount of product used, to find the dose at which establishes a compromise between the analgesic efficacy of the compound for pain relief and side effects that its use results which keeps the risk / benefit ratio within acceptable limits.

Unfortunately, in the case of pain in later life, the situation is paradoxical. "While it takes time to balance analgesic treatment and learn to live with the pain, in the case of pain in later life, the clock is ticking," testified the specialist.

And practice in daily life, given that "we can not bear to feel helpless about the pain and suffering of others," or "to be a witness against the terrible face of death and life, "the titration phase is often overlooked. Thus, some patients may directly receive large doses of morphine because they suffer too, she said. In other cases, to ensure that patients do not suffer, they receive doses can be increased even if their provide adequate relief.

The complications that arise at this time are not due to morphine itself, but the conditions under which it was used. To avoid reaching such extremes, Dr. Isabelle Morin therefore advised to "take the time to care" pain at the end of life, do not hesitate "to seek advice from colleagues or transfer a patient. " And above all, we must not "ask morphine to solve all the problem of pain," which is totally impossible since we can not "do without listening to the subject with" at- she repeated.

On the occasion of the World Day against the pain, Martine Ham, general secretary of the association "Hospital 2000 - To overcome the pain" was estimated at 5,000 the number of missing morphine pumps in public health facilities and private to relieve patients including postoperative pain and those related to cancer and AIDS.

Determined to help finance the purchase of 1,000 pumps, she then turned to corporate sponsorship and private donations. Having already raised the funds necessary to finance 535 pumps, Martine Ham launched Operation "an elected official, a pump" inviting senators, MPs, regional presidents and generals, as well as the mayors of France councils, each fund a morphine pump for a school in their district. She then told Reuters Health expect to get "at least one pump for each department."