Pain Control at the End of Life

Overview

What medicines can relieve pain at the end of life?

The goal of good pain management is to have the least possible pain with the fewest side effects. Because each person responds to pain medicines in a different way, it may take more than one try to find the best medicines for you.

Talk with your doctors and your care team about which medicines will help meet your own pain management goals. Let them know how you hope to feel and what things you would like to be able to do.

Some people have pain as part of a serious, but not life-threatening, illness. Others are in the last several months of life. A lot of the same pain treatments can help anyone. But some are most often used near the end of life.

Possible treatments for pain

If your pain isn't severe, non-prescription medicines may help relieve pain. These include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

If these medicines don't help, your doctor may prescribe medicines called opioids. Opioids may be used with other medicines, such as NSAIDs or antidepressants, to treat your pain.

Pain medicines can be given by mouth, such as pills. Some can be given as drops placed under the tongue. Medicines may also be given as a shot, through a vein (I.V.), or through patches placed on the skin . Sometimes medicines are put into the space next to the spine (such as epidurals). Other medicines are put under the lining of the spinal cord.

In some cases, medicines can be given through a device that lets you get more medicine when you need it. This is called patient-controlled anesthesia, or PCA.

Some pain medicines can make you feel sleepy. You might choose to have a certain amount of pain in order to be fully awake and alert. On the other hand, being fully awake may not be as important to you. You may not be bothered by the sleepiness caused by some pain medicines.

The key to managing pain well is to take your pain medicine on a routine schedule, not "as needed." But even with a routine schedule of pain medicine, there may be times when you have pain that is worse than normal. This is called "breakthrough pain." Talk with your doctor about medicines you should have on hand to be prepared for breakthrough pain. And always talk to your doctor before going off your pain medicine. Suddenly stopping pain medicine may cause serious side effects and severe pain.

Sometimes emotional pain can make it harder to cope with physical pain. But it may be helped with other types of therapy, such as counselling. If you and your doctor aren't able to control your pain, ask about seeing a pain management specialist. This is a doctor who finds ways to treat pain that won't go away.

What concerns might you have about opioids?

You may worry that taking opioids will lead to opioid use disorder. Your risk is low if you are using them for end-of-life care. Or you may worry about feeling tired, not thinking clearly, or having other side effects. Your doctor can help you understand any risks or side effects.

How can other symptoms or side effects be managed?

You may have side effects of treatment or other symptoms that bother you. Your doctor may be able to give you medicines or other treatment that can help if:

• You feel like you can't breathe well.
• You don't want to eat or you feel like you are going to throw up.
• You feel tired or weak.
• You have trouble sleeping.
• You have a change in bowel habits, such as constipation or diarrhea.
• You have problems urinating.

Other treatments may also help. These include:

• Stretching, yoga, and movement to help you stay strong, flexible, and mobile.
• Healing touch or reiki to ease anxiety and improve sleep.
• Relaxation biofeedback, meditation, or guided imagery to ease stress.
• Physiotherapy or light massage (not deep tissue or intense pressure) to help you relax.