What Are the Treatments for End of Life Pain?

A. Reed

Most patients receive end of life pain treatment while in palliative care, where the focus is to eliminate uncomfortable symptoms associated with terminal illnesses. Other treatment may be provided while in hospice care, which is provided for patients who are no longer recipients of planned medical interventions. A common typical method of providing pain relief at the end of life is the administration of pharmacologic agents, drugs generally known as painkillers. Treatment of end of life pain can be complex and even with the most potent drugs available, it may still be difficult to get rid of entirely, though physicians do have other ways of solving this problem at their disposal, including neuroablation, radiation, and chemotherapeutic drugs. Non-medicinal options like acupuncture and massage are also effective for some patients.

End of life caregivers must have an excellent bedside manner.
End of life caregivers must have an excellent bedside manner.

Doctors treat end of life pain by prescribing medications, but the type of drug ordered tends to be determined by the intensity and kind of pain experienced. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and acetaminophen are given for slight pain, while more potent medications are prescribed for moderate to severe pain. Fentanyl and morphine are examples of analgesics frequently provided to patients experiencing debilitating pain such as that associated with terminal cancer and acquired immunodeficiency syndrome (AIDS). Regional anesthetics, which are agents used to prevent sensation in a certain area, are administered to patients with severe pain confined to particular nerve tracts.

Morphine is commonly used to treat end of life pain.
Morphine is commonly used to treat end of life pain.

Used mostly to relieve end of life pain caused by cancer, sometimes physicians will cut through nerves or even destroy nerve tissue with heat, a surgical procedure referred to as neuroablation. Electricity may also be used to deaden a nerve route, typically affecting conduction along the spinalthalamic nerve tract, preventing impulses from being delivered to the brain where it would normally be interpreted as painful stimuli. Neuroablation is an aggressive effort to alleviate serious pain that could not otherwise be helped. Effects of this surgical procedure are long-term pain relief which can also be permanent in certain cases.

Terminally ill patients may receive end of life pain treatment to eliminate uncomfortable symptoms.
Terminally ill patients may receive end of life pain treatment to eliminate uncomfortable symptoms.

Even though the hospice patient does not receive treatment intended to produce a cure, doctors do sometimes prescribe a brief regimen of palliative radiation or chemotherapy strictly for purposes of relieving end of life pain. Generally indicated for pain typically resulting from lymphoma, as well as metastatic bone and brain malignancies, palliative radiotherapy or chemotherapy works to stop the continued growth or spread of neoplastic cells. Side effects of these treatments tend to be problematic, although, according to some researchers, both chemotherapy and radiotherapy are helpful to certain patients receiving hospice care as of 2007.

Pain also can be alleviated by unconventional means that are non-pharmacologic and considered to be non-invasive. A very old therapy developed by the Chinese, acupuncture is performed by inserting long, fine needles through the skin at specified areas on the body. Many patients and acupuncturists indicate that, not only does it work in reducing pain, but also for other symptoms including anxiety and nausea. Other non-medicinal remedies that may be used include guided imagery, massage, and relaxation exercises. Such methods are often combined with more conventional forms of treatment in order to ensure adequate pain relief.

Radiotherapy, such as with a linear accelerator, might be used to treat end of life pain associated with cancerous cells.
Radiotherapy, such as with a linear accelerator, might be used to treat end of life pain associated with cancerous cells.

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