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Pain is an unpleasant physical and emotional experience due to some physical damage. There is no measure of pain. Self-report is the only valid gauge of pain. At times, patients may be unable to report their pain. In those circumstances family members, friends, or caregivers are asked to gauge the pain. At the end of life, many patients cannot communicate their pain due to certain poor conditions. If the patient has any potential physical reason for discomfort, they are considered to have pain until proven otherwise.

What is known about pain?

Some form of pain may be experienced by patients at the end of life stage. Headache, abdominal pain, and chest pain are the most frequently reported types of pain. Patients need to communicate about pain and try to get relief. Inadequate pain relief increases stress. It can worsen the physical conditions and impair quality of life.

What types of pain exist at end of life?

Pain can be broadly divided into two main types: nociceptive and neuropathic. Nociceptive pains are usually related to damage to bones, soft tissues, or internal organs. Nociceptive pains include somatic and visceral pains. Somatic pain is aching, throbbing pain. Arthritis is an example of somatic pain. Visceral pain is squeezing, cramping pain.

Pain may be always present. This is often termed baseline pain. Additional pain may occur occasionally. This is called breakthrough pain. People at the end of life often have both types of pain.

What should patients do if suffering from pain?

Rate your pain on a scale of 1 to 10 and report it. Tell you doctor or nurse how bad your pain is and the area it hurts. Take your pain medication on time. Use other methods of pain relief like hot or cold packs. You can also listen to relaxing music or watch TV to distract yourself. Try maintaining a record of your pain. This may help the health care provider to diagnose better.

What are the barriers of pain relief related to patients?

  1. Reluctance to report pain.
  2. Concern that reporting pain may distract physicians from treatment of underlying disease.
  3. Fear that pain means disease is worse.
  4. Concern about not being a "good" patient.
  5. Reluctance to take pain medications.
  6. Fear of addiction or of being thought of as an addict.
  7. Worries about unmanageable adverse effects.
  8. Cost concerns for medication.
  9. Concern about becoming tolerant to pain medications.
  10. Consider pain to be a normal companion to aging.
How do people cope with pain?

People are often unable to use the word "pain". This may be due to many reasons like indifference to pain, or concerns about being seen as a complainer. Some people believe that admitting to the pain makes it real. Other factors could include cultural biases, or other causes. "Discomfort" is the most frequently used alternative. Other terms may include "hurt" or "ache". Some terms suggest emotion, such as "distressing" or "horrible".

Many patients have multiple pain areas. The body area of pain can be referred, like pain in the shoulder. When people report "pain all over", this generally refers to total pain or distress. Patients should try to be less fearful, less anxious of pain and should report it.

How can pain be relieved?

Pain could be relived through pharmacological and non-pharmacological ways. The non-pharmacological ways include cognitive or behavioral therapies (like relaxation, guided imagery, distraction, cognitive reframing, support groups, and pastoral counseling and prayer), physical measures (like massage and repositioning) and complementary therapies (like herbals, magnets etc).

For more information e-mail lifeend@msu.edu or call (517-432-5511) End Of Life Research Center at Michigan State University.