Pain Management in Terminally Ill Patients

Uncontrolled pain is a large issue for patients with end of life illnesses. Studies reveal that the majority of pain problems is as high as 50% among older folks at the end of life. It is estimated that one out of four elderly cancer patients in nursing homes receive no treatment at all for daily pain. Acute or chronic pain is reported among 30% of newly diagnosed cancer patients and increases from 60% to 80% among patients with advanced disease.

Screen Shot 2015-12-02 at 11.07.44 PM

Although cancer is the illness that is usually associated with pain at end of life, patients with non-cancerous terminal illness, including AIDS, end-state cardiac, pulmonary, and cerebrovascular diseases, such as Alzheimer’s.

Patients are sometimes reluctant to report pain to physicians because of the fear of being regarded as complainers. Older patients may worry about being involuntarily being hospitalized or having additional tests or procedures. Denial may be a defense mechanism to avoid confronting the prognosis implication of increasing pain.

Concerns about addiction should be of minimal worries to the majority of terminally ill patients. However, may doctors continue to confuse physical dependence with addiction. Physical dependence is the largely, unavoidable physiological adaptation to opioid use that requires continued use of the medication to avoid withdrawal. It usually happens within day to weeks of starting opioids. For those patients in which the source of pain is taken away, opioids may be quickly and safely tapered down without continued need for the medication.

Screen Shot 2015-12-02 at 11.20.16 PM


Addiction, in contrast, represents a state of psychological dependence in which the patient shows a behavioral pattern of drug craving and great amount of involvement in obtaining and using the drug for reasons other than pain. Addicted patients tend want to acquire the drug despite financial, legal and psychosocial difficulties.

Many doctors still have a poor understanding of opioid pharmacology and are fearful of causing addiction, significant respiratory depression, or premature patient death. The fear of the development of analgesic tolerance usually prompts doctors to withhold opioids from patients with severe pain until they are near death.

In the end of life care, it is important that we achieve relief of pain, preventing pain recurrence, optimizing the patient’s sense of well-being and restoring a sense of hope and belief in the value of life. The goal is to provide the least obtrusive, least sedating and most effective analgesic treatment.

This article was brought to you by Dr. Senegal, pain management MD with Sutter Health and Jennifer Lin, RN with Vitas Hospice Healthcare.

Why I Chose to Take a Luxury Sedan to the Airport

Trips to the airport should not be a stressful ordeal. I have had the experience of using taxi cabs in the past for a 45 minute trip to the airport. One of my colleagues mentioned to me that he has been utilizing the services of San Francisco Limousine. My initial thought was, “But why would you want to take a limo to the airport”? He explained, to my surprise, that limo companies are one of the best kept secrets in the transportation industry. Many of their businesses come from corporate and airport services. Almost every limo company carries, not only limos, but sedans like Lincoln Town Cars and SUVs. In fact, the majority of their business comes from corporate and airport services.

Screen Shot 2017-02-20 at 10.50.50 PM

My next thought was that it must cost more to hire a limo company for an airport transfer. The fact is, it costs just about the same as a taxi fare. The difference between riding a cab versus a limo hire sedan, well there are many. First, there is a level of class and professionalism that comes with a limo hire car. Second, the vehicles have more comfortable seating and the companies usually provide complimentary bottled water for your refreshment. You also get a professional chauffeur who personally opens your door and assists you with your luggage. Limo companies also have the option of “meet and greet” which is having the chauffeur wait for you inside the airport with a sign upon arrival to airport.

After hearing such good reviews about this I decided to call San Francisco Limousine and booked a pick up from Oakland to SFO international airport. My driver, Dan, arrived 10 minutes early and helped with my luggage. He was very polite and well-mannered. We arrived at the airport with ample time to check in and get through security check point. All-in-all, the experience with this company was great and I tipped the driver at the end. There is certainly a noticeable business etiquette with using a limo company.

These sedans are best to be booked in advance. That is the one disadvantage to using a limo company over a cab. Taxi cabs sit and wait and if you need transportation at the last minute, they may be the best option. If you were to call a limo company, they would have to determine how far the driver is to the airport and how soon he could get there, which could be in 30 minutes.