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Pain Management

If you suspect your loved one may be in pain, but he or she refuses to talk about it, check for the symptoms listed below.  If he or she displays these symptoms, talk with your hospice team nurse immediately: 

  • decreased appetitepain cycle
  • lost interest in normal activities
  • he or she avoids moving, stays in bed and doesn’t get dressed
  • he or she grimaces or winces when moving
  • difficulty sleeping
  • crying or obvious distress

The goal of hospice care is to provide comfort and to help patients live the last months of life as fully as possible.  To achieve these goals, patients must be as free as possible from pain and other distressing symptoms.  Your hospice care team is very experienced and knowledgeable about pain management techniques.  Please contact your hospice team nurse or physician if you or your loved one has questions about pain management.

Pain is a very personal experience.  Only your loved one can define what pain is to him or her.  Only he or she can accurately describe the amount of pain and how well it is being relieved.  Sometimes, though, people are reluctant to talk about their pain.  They might feel that:

  • they are not supposed to have pain
  • pain is a sign of weakness
  • nothing can be done
  • they shouldn’t talk or complain about the pain

Pain affects physical, psychological, emotional, social and spiritual well-being and can be compounded by other problems you and your loved one are experiencing (see pain cycle graphic). Your hospice care team will help you address and work through these issues.

By openly discussing the pain with your hospice care team, you and your loved one can take control, minimize the pain and increase your loved one’s quality of life.

Pain medications can be administered in different forms, including:

  • pills
  • liquids
  • infusions under the skin or into a vein
  • suppositories
  • patches worn on the skin

Acute Pain and Chronic Pain

Acute pain usually comes on suddenly and has a very distinct cause, such as the pain experienced with a heart attack.  Changes in pulse, blood pressure and facial expression often accompany acute pain.

Chronic pain is less well-defined in terms of its onset and lasts for more than six months.  Changes in personality, functional ability and lifestyle may come with chronic pain.  Examples of chronic pain include chronic back pain and pain due to cancer.

Hospice patients generally experience chronic pain from their illnesses.  However, there may be times when they face episodes of acute pain.  Cancer is often associated with episodes of pain, but patients with non-cancer terminal illness experience pain, as well.

Communicating Pain and Discomfort

Your HCI Hospice Care Services care team will work closely with you to measure and monitor your pain level, set pain management goals and determine the best means of managing your pain.  HCI Hospice Care Services uses several different tools to effectively measure pain levels:

  • Numeric (1-10) pain scale
  • Verbal descriptor scale
  • Faces pain scale
  • PAINAD (Pain Assessment in Advanced Dementia) scoring tool

Talk to your HCI Hospice Care Services care team to learn more about these pain scale tools. 

Pain Medication and Side Effects

Although pain medications often have side effects, they can almost always be dealt with effectively. Always report any side effects to your hospice team nurse or physician. 

Always dispense prescribed medications as the physician has instructed—whether they are to treat the pain or the side effects.  Common pain medication side effects include:

  • nausea
  • constipation
  • drowsiness

Mild Pain

Mild pain is treated with:

  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • acetaminophen
  • aspirin

Occasionally, antispasmodics, antidepressants or other medications may be used to provide better pain control.  Mild pain can often be treated with over-the-counter medications; however, some NSAIDs require a prescription.

Moderate Pain

Moderate pain is treated with weak opioid drugs such as:

  • codeine
  • oxycodone
  • hydrocodone

These medications may be combined with other non-opioid medications to enhance patient comfort.  These medications require a prescription.

Severe Pain

Severe pain requires the use of stronger opioids like:     

  • morphine
  • hydromorphone

These medications also require a prescription.

The truth about opioids

  • Addiction to opioids is very rare for hospice patients.They take the medication because they have a genuine need for pain relief, not because they crave the drug.
  • Opioids do not hasten death. They are introduced gradually, allowing the body to adjust to their effects.For hospice patients, improved pain control often leads to better quality of life.
  • Many side effects can be quickly treated.Side effects such as drowsiness often go away after the first few days. Constipation, however, requires additional intervention.