End of life care

Managing pain and other symptoms

Managing symptoms, including pain, is an important part of end of life care.

Each person will have different symptoms depending on their condition and the kind of treatment they may be having. Symptoms might include nausea and vomiting, constipation, loss of appetite, and pain. The palliative care team will work together with your doctor to manage your symptoms and help you feel as comfortable as possible. You can read this whole article or click on the links below to go straight to the relevant section:

Pain

How is medication given?

Nausea and vomiting

Constipation

Loss of appetite

Other methods of symptom management

Pain

Not everyone approaching the end of life has pain, but if you do, your doctor or nurse will assess it and decide on a suitable drug and the correct dose to help manage it. They will ask you (or your family or carers if you are not able to communicate) questions about the pain. These might include:

  • where it is located
  • when it started
  • the effect it is having on you, for example whether it is stopping you from sleeping

Sometimes the doctor or nurse will ask the palliative care team to advise them. Pain-relieving drugs are available at home, in hospital, in a hospice, and in a care home.

Your doctor or nurse will use the weakest painkiller available that is effective in keeping you free from pain. In order of strength (starting with the weakest) there are non-opioid painkillers, such as paracetamol; then mild opioids, such as codeine; and strong opioids, such as morphine.

An opioid is a chemical that works by binding to special opioid receptors in the body (found mostly in the central nervous system and gut), which reduces the pain we feel.

How is medication given?

You will usually be given drugs in the least invasive way possible. This means that they will be given in a way that causes the least amount of discomfort, pain or distress.

The first step is to take them by mouth (orally). If this is not possible, for example if you are vomiting or cannot swallow, painkillers can be given:

  • through an injection under the skin (subcutaneous)
  • through an injection into the muscle (intramuscular)
  • directly into a vein (intravenous)

Sometimes a small, battery-operated pump called a syringe driver is used to give medication continuously under the skin for a period of time, such as 24 hours. You might be offered a syringe driver if you cannot take medication by mouth, for example if you are being sick or have difficulty swallowing.

There are also some strong painkillers that can be given through a patch on the skin.

Sometimes supplementary (adjuvant) painkillers are used alongside non-opioid and opioid painkillers. Adjuvants include medicines that are designed for other conditions, such as epilepsy, but work well with certain types of pain.

Some drugs can have side effects, such as making you feel drowsy or sick. Talk to your doctor, nurse or palliative care team, who can help with managing these side effects.

Macmillan Cancer Support has useful information on describing your pain. This can help your doctor or nurse to understand the kind of pain you are feeling, and work out the best way of treating it. The information is written for people who have cancer, but is relevant for anybody who is experiencing pain.

Nausea and vomiting

Your condition or medication may make you feel sick or vomit. There is anti-sickness medication that you can take, so talk to your doctor or nurse if you are feeling sick or being sick.

You can also try some self-help techniques that may help you to feel less sick: 

  • eat small amounts often, rather than trying to eat large meals 
  • eat dry, carbohydrate food such as toast or crackers

Some people find that ginger helps, for example ginger tea (you can buy ginger tea, or make it by adding peeled, fresh ginger root to hot water), stem ginger, ginger beer, or ginger added to food.

Constipation

Constipation can be a side effect of some medications, and can also happen if you are not eating and drinking as much as usual. Your doctor can prescribe laxative medication to help with this, so tell your doctor or nurse.

If you are able to, you can try some self-help techniques, such as: 

  • eating foods high in fibre, such as brown rice, wholewheat pasta and bread, fruit and vegetables
  • drinking as much fluid as you can

Loss of appetite

You may not feel like eating much, and this could be because of your condition or medication. Try to eat small amounts. It might be helpful to have snacks nearby. 

As you near the end of life, your body may not be able to digest food as well as it has in the past. At this stage, do not force yourself to eat if you don’t want to. Your doctor or nurse can discuss your appetite with you, and talk about how much you should be trying to eat. This information can be helpful for your family and carers too, as they may be worried if they feel you are not eating enough. If your partner, friends, or carers want to find out more information about caring for someone at the end of life, they can go to Carers Direct: end of life care.

Other methods of symptom management

There are ways of managing pain and other symptoms without using drugs. These include physiotherapy and complementary therapy.

Physiotherapy, often referred to as physio, uses physical methods such as exercise and manipulation to promote healing and wellbeing.

Some people find that complementary therapy, such as massage or reflexology, can help them to feel more relaxed. Many hospices offer complementary therapies.

You can talk to your doctor or nurse about the kinds of pain management that might be available to you. Always tell your doctor or nurse if you're using any complementary therapies.

 

Page last reviewed: 09/10/2012

Next review due: 09/10/2014

Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Concerned about protocol driven care said on 22 November 2012

I agree with Ellie G and redge007. The district nurses in my Mother's case were slavishly following some unseen protocol which prevented them setting up a syringe driver. Instead they wanted to wait until my mother was in severe pain and then we would have to wait for a nurse to visit to give an injection. They failed to see that the situation was unstable and deteriorating and they failed to listen to both patient and carers. It has caused great distress at an already difficult time, and it will take a long time to erase the memory of some of the uncaring , arrogant and unprofessional district nurses. When a sensible and caring nurse came, the syringe driver was set up with no fuss and the pain and other symptoms were very soon under control

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redge007 said on 19 December 2011

I totally agree with Ellie G. My mother is pallative and at home to die. She is in constant pain even though she has a syringe driver fitted. We are constantly on the telephone calling for a doctor to come out and increase her meds. We are led to believe by palative care nurses that the end of life will be as pain free and comfortable as possible, I disagree.

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Ellie G said on 09 August 2011

Having cared for both my parents during their end of life it seemed to me that the pain relief offered was always insufficient for their needs. The palliative teams always delayed pain relief, delayed increasing drugs or changing drugs. This was alarming at times and caused suffering. It seems the medical teams are still afraid of being accused of hastening death even if the faster journey, with better quality of life, is what the patient wants. The power to determine pain relief should be exclusively made to the patients wishes, their advanced statements, or their family and loved ones. The changing faces of the palliative and medical teams do not offer any individual care - they simply follow pre-determined protocols in the main.

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Karmer said on 16 March 2011

This article does not mention the reality that painkillers use. There is no possibility that painkillers are fully "effective in keeping you free from pain". There use is limited and is the skills used to judge pain and decide on what painkillers to use. It would be fairer to talk about pain reduction which itself has to be offset by the side effects. With these failings in care it is little wonder to euthanasia is alive and well.

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