Pain at the End of Life

Pain at the end of life is influenced by a complex interplay of a person’s physical, cognitive, social, and spiritual experiences throughout their life. End of life is commonly described as the phase of life when a person is living with, and impaired by, an eventually fatal condition. Individuals in need of pain care at the end of life represent a group at increased risk of vulnerability, often with a lower quality of life and inadequate end-of-life pain management. Several factors increase vulnerability at the end of life, including clinical, social, cultural, structural, and economical barriers. Geriatric patients particularly may be among the most vulnerable adults, with factors such as frailty, cognitive impairment, lack of social support, and loss of independence resulting in negative outcomes. End-of-life care is often interdisciplinary and brings a unique and holistic perspective to address the needs of patients and families. As part of the interdisciplinary team, palliative care addresses pain and symptom management to patients at all stages of serious illness through evidence-based practices. Yet, many patients and families continue to experience unmet pain and symptom management. Hence, inclusive and accessible end-of-life pain management can become possible through building on the existing strengths in palliative care and addressing existing barriers to ensure better outcomes. This chapter defines dimensions of pain at the end of life and identifies specific, evidence-based strategies to evaluate and provide end-of-life pain relief. It also reviews the challenges faced during end-of-life pain management and suggests best practices.