Ease my pain. 2

Joan Bakewell explores end of life experiences; many people fear the pain at the point of death most of all. Unfortunately, the only way pain can be totally eradicated medically means that the patient can lose their independence and consciousness. Dr Jonathan Martin, Consultant in Palliative Care at Central and North West London NHS Foundation Trust, and Reverend Saskia Barnden, Lead Chaplain at Birmingham St Mary's Hospice, discuss pain and palliative care. They consider the perception of pain both physical and psychological. Both are palliative care practitioners and consider emotional and spiritual pain. Mike Bennett talks about palliative care and the lack of training in hospitals. There may be several reasons for this; there is anxiety around prescribing strong medication. A patient, Jocelyn, has progressive cancer and describes her pain. There are three types of pain relief; the strongest opiods initially worried her but as Moira Cookson, a senior pharmacologist, explains the dose can be matched to the patient. Jocelyn has accessed hospice support for her medication. However, side-effects such as nausea and treatment for constipation can cause a significant additional burden of tablet consumption. A patient, Jean, corroborates this (she died shortly after her interview was recorded). Janet Trundle describes how pharmacists are getting involved in accessing medication for palliative care. Unfortunately, there is a widely held misconception that opiods precipitate death. Harold Shipman, a serial killer of seriously ill patients with opoids, has cast a long shadow over GPs who want to prescibe medicine to their terminally ill patients but are nervous of doing so. Roger lived with prostate cancer; his wife Zilla talks about how they coped. Louise Lee has set up a 24 hours palliative care service in rural Lincolnshire; but they are still up to an hour away. Moving from oral medicine to injections can mean the loss of control in the medication process. Zilla was vetted and trained to administer pain relief. She became part of the team. However, near to the death of a loved one families can be under considerable stress and this is the point at which many access hospice services. People of different faiths have different approaches to accepting pain relief and it's difficult for medical staff to honour patients' wishes when they can see there is pain. Patients have the opportunity to create a statement and create a document on advance care planning.