Managing Pain at the End of Life

Posted on June 6, 2019

Is death painful? Whether you are coming to terms with your own terminal illness or caring for someone who is nearing the end of life, you may have considered this question. A better understanding of pain and how to treat it can help create a more comfortable and gentle dying process for the patient and their family members.

Understanding End of Life Pain
The end of life does not need to be painful. According to June Dahl, founder of the American Alliance of Cancer Pain Initiatives, thanks to modern medicine, about 90-95% of all dying patients should be able to experience significant relief from pain. When a patient is receiving hospice care, they usually will experience very little pain, or even no pain at all, during the dying process. Instead, their body will naturally shut down as they progress through the stages of dying. Pain can and should be treated at the end of life to allow for a peaceful death.

While pain at the end of life is preventable and manageable, up to 35% of patients describe their pain in the last week of life as severe or intolerable. There are several reasons for this staggering and heartbreaking statistic. Lack of understanding about options for support, along with myths about pain medication at the end of life can have detrimental effects on the patient and family’s wellbeing. Thankfully, by clearing these myths and understanding the intricacies of pain at the end of life, we will be better able to speak and act for ourselves and our loved ones.

First, lack of communication between the patient, physicians, family members, and caregivers can lead to an unnecessary amount of pain. While some patients might try to “tough it out” or be a “good” patient, it’s important to let your doctor or hospice care provider know when your pain is becoming unbearable. Patients may also be in denial about their worsening condition, and thus they may be reluctant or afraid to admit that they are in pain.

Some people fear that they will become addicted to pain medication. Yet, once a person is diagnosed with a terminal illness, addiction should no longer be a concern. Some people also fear that they will become tolerant to certain pain medications, and the relieving effects will wear off eventually. If medication tolerance develops, a different or stronger medication can be used. Others believe that pain medication hastens death. This is simply not true. Studies suggest that treating end of life pain with narcotics does not shorten life.

Finally, patients and family members may be hesitant to properly utilize pain medication due to the costs. Sadly, terminal illness often acts as a financial burden to families, and pain medication may be yet another expense.

Managing Pain at the End of Life
No one should die with uncontrolled pain. The best way to make sure that patients’ pain is controlled is by opening up a conversation about what they are experiencing. It is critical for patients to speak honestly with their doctors about their level of pain. But as noted above, this doesn’t always occur. This is where caregivers, hospice providers, and family members come in. "You can't depend on the patient to tell you when they are in pain. You have to ask," says Dahl.

Hospice programs typically are well-equipped to ease pain at the end of life and allow patients to die with dignity. Since hospice programs can deliver care in one’s own home, patients often feel less anxious and more relaxed as they go through the dying process surrounded by their family and other loved ones. Aside from pain medication, there are other useful ways to manage pain, including alternative therapies like massage and music therapy. These complementary techniques can help ease physical pain while also reducing anxiety levels and preparing the patient to pass away peacefully.

You can find more information about hospice programs and alternative therapy offerings near you in our Resource Directory.