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End of life pain management under the scope


Steve Spinks
31 July 2012
A recent $26 million announcement by NSW Health Minister Jillian Skinner to fund an overhaul of pain management services in the State has been welcomed by Professor Colleen Cartwright, director of Southern Cross University’s Aged Services Unit.

“I’m delighted to see this funding. It’s excellent that the Minister is talking about an overhaul for pain management in NSW. Indeed, I would encourage all states to follow suit,” she said.

Professor Cartwright said the announcement was particularly important for regions such as Tweed Heads.

“The Minister’s commitment of $26 million over the next four years to support the development of new pain management services in regional areas is particularly important given that the Tweed has one of the highest percentages of older people in the State," she said.

“Furthermore, the state electorate of Tweed has the highest number of people suffering from dementia in the State, according to a Deloitte Access Economics report. Indeed the North Coast is over-represented in this area with Port Macquarie, Coffs Harbour and the Clarence in the top 10 electorates in the state and Lismore and Ballina in the top 30.

“It should be noted that older people and those suffering from dementia often don’t receive adequate pain relief. So while the funding announcement is excellent, I’m concerned that the focus of this money is on chronic pain services and while that is important, because people living with pain have a totally diminished qualify of life, there is also a need for a specific focus for pain relief at the very end of life.

“My research over the past 22 years continues to demonstrate that that is being poorly done in many places and recent cases brought to my attention demonstrate that.”

In a recent account told to Professor Cartwright, a very frail elderly man fractured his hip on a Friday afternoon and was admitted to a NSW hospital. The treating medical practitioner decided he was too frail for surgery. He was clearly in agony and his daughter requested more pain relief and a palliative care consultation. She was told that no palliative care staff were available on the weekend. Nurses came to roll him, to avoid bed sores, without any additional pain medication. On the third occasion the man looked at his daughter with terror in his eyes and said ‘Not roll, not roll.’ The daughter then had to threaten the nurses with physical violence to ensure they stopped rolling him.

“From my earlier research, the community don’t believe that doctors can control pain in terminally ill patients as much as doctors believe they can control the pain,” Professor Cartwright said.

“The above case, while extreme, and other cases have made me realise that the situation is getting worse so I’m now considering the best way to do more research in this area and I would be interested to hear from anyone in the community who has had similar experiences.”

Photo: Professor Colleen Cartwright.