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Multi-Sensory Environments: Changing Attitudes about Pain, Palliative Care and Hospice
According to the American Cancer Society, research shows that one of three patients being treated for cancer and about two-thirds of patients with advanced cancer, experience pain. But less than half receive adequate relief for their pain. Although Multi-sensory Environments have been utilized for the reduction of pain in Europe and other countries almost since its inception, MSE has been in the United States only since 1992. In the US, it has been utilized primarily for recreation, education and therapy for those with various disabilities and dementias. Research studies have suggested that Multi-sensory Environments reduce anxiety and relieve stress. Due to this trend MSE may have application in other areas of the human experience where pain and anxiety often exists namely within Palliative Care and Hospice.
In January of 2001 a joint project of the American Cancer Society and the National
Comprehensive Cancer Network developed and released the “Cancer Pain: Treatment Guidelines for Patients.” Accreditation standards for hospitals, nursing homes and other health care institutions also changed. Specific standards on pain assessment and treatment, as well as education of both staff and patients on pain management, are now required.
Doctor Janet Abraham, a faculty member in the department of medicine at Harvard Medical School, said of this release, “We want to treat the pain with as much care as we want to give to treating your cancer.” Dr. Abraham, who is the author of A Physician’s Guide to Pain and Symptom Management in Cancer Patients, has also said that ninety percent of cancer patients could get their pain relieved by taking medications.
The cancer pain guidelines list various possibilities including: surgery; heat and cold therapy; massage; hypnosis; acupuncture; and transcutaneous electric nerve stimulation. Medications can be delivered via intravenous; injection; implanted pump; and nerve block. If these treatments do not work well, other options are available.
Dr. Abraham said, “There has been an explosion of new treatments for pain, and I definitely think the medical community is eager to understand more about what they can do.”
As I read Dr. Abraham’s article, I thought of the times in my career when I sat with a dying patient. Back in 1975 there was no movement to address the pain like there is today. I’d visit dying patients daily and bring activities to their bedside. Many of these patients started our sessions together by talking about their pain. But as we conversed, their thoughts would transition to pleasurable memories and, after awhile, the discussion of pain would phase out. I was helpless to do more than listen.
Except for one particular patient. This woman loved classical music and so, at every visit, I would change the station on her RCA tube radio to the one she preferred. After her death, I found she had willed the radio to me.
That circumstance made an indelible mark on my awareness of sensory issues and palliative care. We all want to die with dignity, at peace, and at home or the place of our choosing. We do not want to be in pain. As I read the list of guideline options, I realized they all require that something be done to me. Some of the techniques are more invasive then others. All but one technique requires physical handling. I asked myself, what would I want? I would want to be in the least amount of pain as possible and to enjoy as much time as I had with my loved ones. I’d want to die in the place of my choosing. Unfortunately or fortunately depending on your perspective or culture, we do not always have a choice.
The use of Hospices is increasing. Hospitals are addressing the ethics and hard questions about dying and living with complex illnesses through Palliative care. There is more communication between families, patients and hospital teams involving new care options. So, in the interim what can be done to help other patients and families in critical care situations that are not yet part of this mainstream change? I believe the answer lies in creating an environment that can help ease the pain and establish an atmosphere to decrease the stress for both family and patient.
The Multi-Sensory Environment can fulfill some of this need by changing the perception and emotional appeal of the surroundings. We cannot change the outcome of losing a loved one but we can help make the final environment comfortable, pleasant, peaceful and conform to the last wishes of an individual and their family.
An MSE is non-invasive and patient directed. MSE equipment can change a hospital or hospice room into an oasis of calm. Its soothing music, smells, and gentle revolving lights divert focus away from pain. MSE can reduce anxiety, decrease stress, and allow families continued opportunities to share memories and this last life experience together. It spans all ages and can be as interactive as a patient desires. It can help produce a Spiritual atmosphere. Most patients will tell you how tired they are with the routines of medical procedures no matter how necessary they are. MSE helps preserve patients’ dignity by giving them choice and empowering them with control.
For patients at the end stage of life, the only issues are comfort and quality of life. It is about continuing to Live Life to its utmost, and celebrating that Life. Multi-Sensory Environments offer an alternative to traditional modalities and allow for dignity and quality of life.
National Consensus Project for Quality Palliative Care (2004). Clinical practice guidelines for quality palliative care. http://www.nationalconsensusproject.org
Hadjistavropoulos T, LaChapelle DL, MacLeod FK, et al. Clin J Pain. 2000, 16:54-63 Gibson SJ, Helme RD. Pain. 2000;85:375-383
Schofield P., MSE/Snoezelen: is potential for people with chronic pain. Complement Ther Nurs Midwifery.1996 Feb; 2(1):9-12. Review.