End-of-Life Evaluation and Management of Pain

Excerpt

Pain and discomfort at the end of life are frequently under-recognized and undertreated. With the advent of modalities that help prolong life, there is a constant risk of prolonging suffering. Health care practitioners are entrusted with the responsibility of ensuring their patients' comfort and need a holistic approach targeting pain at the end of life. In their efforts to define the concept of a “Good Death,” narrowed down on 36 studies that addressed the parameters for good death defined by patients at the end of their life. Having a pain-free status was one of the top three priorities noted, with 81% of the studies significantly weighing on its importance.

Saunders conceptualized the concept of “total pain” in evaluating and managing pain in the dying. The concept of total pain encompasses four components, notably the physical noxious stimuli, emotional discomfort, interpersonal conflicts, and the nonacceptance of one’s own death. To alleviate the discomfort of the dying, all four of these attributes of pain need to be addressed.