Managing Pain at the End of Life

One of the first questions we ask hospice patients is, “what really matters to you at the end of life?” Managing pain is often at the top of their list.


Recent evidence shows that patients who get specialized care for their pain live longer, have less depression and a higher quality of life during the course of their illness. That specialized care is called palliative care, a medical practice focused on relieving the pain and stress of a serious illness.


A study in the New England Journal of Medicine found that patients with the most common type of lung cancer who received palliative care lived almost two months longer than those not getting palliative care. 

Have conversations about pain early and often

Effective pain management begins with a conversation about your current goals and what you want as care progresses. Everyone deals with pain and pain medication differently. This is your time to honestly share your current level of pain, your tolerance for pain and how you want caregivers to respond to your pain in the future.


If a patient is unable communicate their level of pain, our hospice team has experience working with families to identify pain and co-manage treatment.


A doctor or nurse may ask about the kind of pain a patient is experiencing. Different kinds of pain, such as bone pain or nerve pain respond to different medications. Knowing if the pain is in one place or radiates, if it’s constant or comes and goes, helps patients get the right balance of medications and therapies. 

Staying ahead of the pain

Understanding how and when to take medications is essential for controlling pain. Most pain medications need to be taken on a strict schedule and exactly as prescribed, regardless of current levels of pain.


“I often share a story about how pain medicine is like water and pain is like dry wood ready to catch fire,” say Synthia Cathcart, Vice President for Clinical Education and Development at Compassus.


“If you keep a piece of wood wet, it’s difficult to burn. But, if that wood gets dry and catches fire, it takes a lot of water to put out the flames. Pain medicine is like the water that prevents pain from flaring out of control.”


Questions to consider about pain management


  • Will my pain medications make me unable to function?
  • Will I get opioids for pain and are they safe?
  • What about side effects?
  • What about a sudden onset of pain? 

Will my medications prevent from functioning normally?


Managing pain is about finding the right balance of pain relief while maintaining quality of life. This requires honest and regular conversations with your doctor, nurses and pharmacists.


Don't let pain or pain medications overshadow your life. On a practical level, our team works to offer the right drug, at the right dose, at the right time.


Will I get opioids for pain and are they safe?


Opiate medications are an effective option for aggressively treating pain, but only prescribed when they are timely and effective. Some of the fears about opioids aren’t relevant to hospice care.


The grogginess associated with opioids almost always tapers off after a few days, without any loss as an effective treatment for pain.


When opioids are used as prescribed, addiction is not typically a problem for hospice patients. Patients should never feel ashamed about taking a doctor-prescribed medicine to ease the pain of a terminal illness.


Families sometimes fear that opioids will hasten their loved one’s death. Again, studies and experience show that proper use can extend life.


What about side effects?

Medication side effects, including constipation and nausea, are often easily controlled in hospice patients.


What about a sudden onset of pain?

Hospice providers are trained to help patients and families during times of breakthrough pain. The keys are close communication with hospice caregivers and having a plan for emergencies.