End-of-Life Pain Management for Hospice Patients

End of Life Pain Management

Written by Amedisys

Symptom control is the central goal of hospice care, which gives people facing a life-limiting illness the freedom to live the rest of their days with comfort, dignity and quality of life. Unfortunately, many at the end-of-life experience severe, uncontrolled pain that isn’t managed effectively. Living with chronic pain makes it harder to eat, sleep, complete daily tasks and enjoy the time remaining.

Amedisys hospice teams focus on caring for the whole person with expert medical care as well as emotional and spiritual support.

Understanding Pain in Hospice Patients

For hospice professionals, pain is whatever the patient says it is.

The first step in effective pain management is talking about it honestly and comprehensively with caregivers and the hospice care team. Some patients may downplay their pain levels to not be viewed as weak or a burden, but hospice care is most effective when our clinicians know exactly what the patient is feeling.

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On each visit, the hospice nurse will check in on pain levels with the following questions:

  • What are your goals for pain management?
  • What kind of pain are you feeling? Examples can include sharp, dull, burning, stinging, tender, nauseating, aching, etc.
  • Where do you feel pain?
  • On a scale of 0, being no pain, to 10, being the worst pain possible, how would you rate your pain?
  • What makes the pain better? This can include lying down, pressure, deep breaths, exercise, heat or cold applications.
  • What makes the pain worse?
  • Does your pain stop you from doing activities of daily living like sleeping, sitting, bathing or eating?
  • Is there a particular time of day the pain is worst?

Patients’ family members and caregivers may also notice non-verbal signs of pain, including agitation, changes in sleep patterns, poor appetite, being depressed or withdrawn, delirium or changes in breathing patterns.

Equipped with these answers and observations, the nurse, in consultation with the physician and the rest of the interdisciplinary hospice team, will come up with a pain management treatment plan.

Hospice Pain Management Medications

The hospice care team can develop a medicine regimen for patients experiencing pain, if appropriate, based on the patient’s goals. Each plan is tailored to the patient and can vary by the type of medicine, the dosage and the schedule. The severity and type of pain will help determine what types of medication interventions are recommended or considered by your physician. It is not uncommon for these recommendations to change as the disease progresses. This can range from over-the-counter drugs like aspirin to mild narcotics to opioids.

While pain medication can be given by pill, liquid, shot or other means, our hospice teams will always opt for the most appropriate route based on the patient’s clinical condition.

It’s important that patients take any pain medication as prescribed, even if they start feeling better. Effective pain management stays ahead, warding off severe pain and making it easier to manage overall. 

Opioid Usage in Hospice Care

When milder medications aren’t enough to meet patients’ goals of pain management and comfort for the end of life, opioids, like morphine, may be the best way to relieve severe pain.

Many patients and family members may feel concerned about the prospect of using opioids. However, when used correctly and as prescribed, they can be effective to treat hospice patients with severe pain. The hospice care team, which includes the hospice physician, will work with the patient when opioids are prescribed, and help implement any change or halt in medication as needed.

Non-Medication Tactics to Manage Pain

Pain medication is not the only answer to manage pain. There are a number of other means of improving patients’ quality of life instead of or in combination with a medication regimen, that your hospice team may discuss or recommend, including:

  • Massage therapy
  • Physical or occupational therapy
  • Relaxation or meditation techniques
  • Heat and cold applications

It’s also important to remember emotional pain. Being at the end of life can cause severe depression and anxiety. Hospice care is such a unique benefit because it focuses on so much more than just the physical pain.

Social workers can help ease anxiety by helping with end-of-life planning, ensuring the family is well equipped with resources and tools, providing direct counseling and referring to community resources when necessary.

Chaplains, or spiritual counselors, work to assess the patient’s and family’s spiritual needs and develop a plan of care to meet those needs.

Sometimes, just a nice visit and chat makes a world of difference. Our hospice volunteers provide a range of support, from reading at the bedside to providing pet therapy to helping with light administrative duties.

Benefits of Effective Pain Management in Hospice

Getting pain under control can make all the difference in the world at the end of life. Hospice care is about empowering patients and their families to live their final days how they want to, without the burden of pain.

At Amedisys, hospice care starts with goal setting. How do you want to live your final days? Are there bucket list items you need help achieving?

Alleviating pain helps patients meet those goals and can contribute to:

  • Improved mood
  • Increased activity tolerance
  • Increased independence
  • Avoiding ER visits and unnecessary hospitalizations
  • Family caregiver relief
  • Overall improvement in quality of life

Is hospice care right for you or your loved one? Contact one of our care centers to speak to one of our hospice specialists.


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