Five top tips for managing pain at the end of life

As part of Dying Matters Week, our Senior Nurse Project Lead Tracey Buckley shares her top tips for healthcare professionals on helping people manage pain at the end of life. 

Being free from pain is one of the biggest concerns for people living with a terminal illness. For healthcare professionals, knowing about the different types of medication that can be used to treat pain is essential.

Taking a holistic, person-centred approach to assessing and controlling pain can give you a better understanding of how patients feel and how you can support them.

Here are Tracey’s tips for managing pain effectively:

1. Pain is what the patient says it is

“Everyone experiences pain differently, so it’s important to avoid making assumptions about the patient’s pain or how they say they are feeling. It’s best to encourage the patient to describe their pain to you, which will be the most reliable insight into what they are experiencing.

If the patient is struggling to describe their pain, you could use an assessment tool like a numbered scale from 0 (no pain) to 10 (worst possible pain), and ask the patient to mark how strong their pain is. Poor pain control is often due to poor symptom assessment, so encouraging the patient to give a full history is really important.”

2. Pain assessment is about more than where the pain is

“Try to find out what type of pain the patient is experiencing – is it shooting, aching, burning, or tingling? Does it travel anywhere? What makes it worse or better? What has the patient tried in the past? What worked and what didn’t? Different medications work on different types of pain and understanding the nature of the pain is crucial to getting effective pain management."

3. Pain can be physical, psychological and/or spiritual

“Pain can be caused by a number of issues besides the patient’s illness, such as constipation, urinary retention and infection.   

Remember that pain can be physical, psychological or a combination of the two. Sometimes, psychological pain increases physical pain. In palliative care this is often known as total pain’. Sometimes, a person’s physical pain may not improve until psychological issues are addressed. For example, they may feel distressed, anxious or isolated.

Talking to the patient and their carer or family members (if they are present) can help you understand the impact pain is having on the patient’s daily activities. It would also be useful to find out if the patient is experiencing significant anxiety or depression relating to what is happening, such as tensions within the family, or any unresolved issues.”

4. Managing pain

"Physical pain may be caused by several different physical processes, so you need to try a combination of different types of painkillers to ease the patient’s pain.

The medication should be matched to the severity and type of pain the patient is experiencing, starting with the lowest dose and increasing as required. The World Health Organisation (WHO) analgesic ladder gives a clear framework for prescribing analgesia and is widely used to treat pain.

You should also consider non-pharmaceutical techniques such as, repositioning and distraction therapies like playing music, reading out loud or looking at photos."

5. Keep up the conversation

“Continue talking to the patient about their pain and whether it’s getting better or worse as their treatment progresses. If it’s possible, speak to them about their preferences about how their pain is managed and whether these have changed. As tempting as it may be, you shouldn’t promise that you will be able to get rid of pan completely. It may not always be possible.”

To find out more about pain management visit: Marie Curie Palliative Care Knowledge Zone

Tracey Buckley is Project Lead for the Marie Curie Palliative Care Knowledge Zone, an online information resource for health and social care professionals who don’t have specialist-training in end of life and palliative care. Visit: mariecurie.org.uk/knowledgezone