Managing Pain Effectively to Assure Quality of Life at End of Life

Pain is the most common symptom among terminally ill patients. Effectively managing the physical pain associated with terminal illness does not extend a dying person's life. However, lessening that pain can enhance the quality of life at the end of life by enabling people to coherently discuss a child's future, put their affairs in order, or perhaps even visit a special place one last time.

"The fear of pain is the greatest fear people have about dying, not the dying itself," according to Eli Perencevich, DO, a retired osteopathic oncologist and former medical director of the Hospice of Columbus in Columbus, Ohio. "But pain does not have to take over and become the person's life at the end of life," he said. "By effectively managing and treating pain, physicians can give patients quality time with their families and friends to discuss their hopes and fears and to tie up loose ends. In effect, give them the best quality of life possible until their end-of-life."

Pain is now considered the fifth vital sign and is entered into a patient's medical chart along with blood pressure, temperature, pulse, and respiratory status. The three main types of physical pain a person can experience during the final stages of life include:

• somatic pain, which is localized in the skin, soft tissue, muscles, and bones;
• visceral pain, a general aching or throbbing in the abdomen and internal organs; and
• neuropathic pain, a tingling, burning sensation in the extremities.

"Pain at the end of life can almost always be treated with oral medications," said Dr. Perencevich. "People don't have to be over-sedated or unconscious to control their pain."

Dr. Perencevich said the best way to approach pain management is to talk to the patient and family members early on. "Patients, family members, and physicians need to discuss how the particular disease will progress, what types of pain the patient may expect to experience, and the options for pain treatment," he said. "And, throughout the end-of-life care process, the fears, anxieties, and other emotional strains patients and families go through should also be addressed."