Effective pain management is one of the most important aspects of hospice care. Yet, many people have concerns or misunderstandings about how pain is treated at the end of life.
Some families worry their loved one may be overmedicated or become addicted to strong medications. Others fear their relative may suffer in silence. The truth is, expert hospice teams focus on balancing pain relief with maintaining dignity and awareness, ensuring every patient’s comfort and preferences are honored.
“Hospice is about maximizing the patient’s quality of life at each stage of their illness,” explains Physician Executive Goldfine, MD at Samaritan.
Hospice providers work closely with patients and families to deliver customized and patient-centered care that reflects the patient’s goals, values, and needs.
Table of Contents
- Pain and other symptoms
- Evaluating pain
- Signs of Pain
- Medications for hospice pain management
- Misconceptions about opioids in hospice pain management
- Emotional and spiritual support for hospice pain management
- Complementary therapies for hospice pain management
Managing Pain and Other End-of-Life Symptoms
Hospice pain management focuses on relieving not just pain but a wide range of symptoms common near the end of life, such as:
- Shortness of breath
- Nausea
- Anxiety
- Constipation
- Swelling
- Insomnia
By controlling these symptoms, patients are more likely to feel at peace and make the most of their remaining time. In fact, studies show hospice patients often experience better symptom management than non-hospice patients with similar conditions.
Hospice care uses a holistic approach that may include:
- Medications for symptom control
- Spiritual Support Counselors
- Complementary Therapeutic services like massage or music therapy
- Family education and companionship
- Trained Patient Volunteers
How Hospice Evaluates Pain
Pain is assessed at every hospice visit. Clinicians use a combination of:
- Numeric scales (rating pain 0-10)
- Facial expression chats (especially for non-verbal patients)
- FLACC scale – observing:
- Face
- Legs
- Activity
- Crying
- Consolability
This thorough evaluation helps patients receive the right treatment. Hospice also addresses emotional and spiritual pain, which can intensify if physical discomfort is left untreated.
If you live in South Jersey and have questions about hospice pain management
for your loved one, please call Samaritan at (856) 596-1600.
Recognizing Signs of Pain
Some patients, especially those with dementia or communication challenges, may not express pain clearly. Family members and caregivers should watch for signs, such as:
- Faster breathing rate
- Tightly closed eyes or rapid blinking
- Elevated systolic blood pressure (the first number) from the patient’s normal level
- Tense or rigid posture
- Rocking, fidgeting, or pacing
- Resisting care or guarding part of the body when turning
- Withdrawn or a Becoming withdrawn or aggressive
- Increased confusion
- Crying, moaning, sighing, or calling out
Recognizing these cues allows caregivers to advocate for effective relief.
“Few things we do for patients are more fundamental to the quality of life than relieving pain, especially at the end of life.”
– American Society for Pain Management Nursing and Hospice and Palliative Nurses Association
Medications Commonly Used in Hospice
Hospice providers aim to use the lowest effective dose of medications to reduce pain and side effects, allowing patients to remain alert and connected. Common hospice medications include:
Acetaminophen (Tylenol): Reduces fever and mild to moderate pain.
Bisacodyl(Dulcolax): Treats constipation, often due to opiod use or decreased intake.
Dexamethasone (Dulcolax): Steroid that can reduce pain and swelling, increase appetite, and relieve nausea.
Lorazepam (Ativan): Reduces anxiety, agitation, shortness of breath, and insomnia.
Haloperidol (Haldol): Controls nausea, delusions, and agitation.
Oxygen: While not technically a medication, helps ease breathing difficulties.
Opioids: Including morphine, relieves moderate to severe pain and shortness of breath.
_____________________
Take a more in-depth look at common hospice medications. Read more now >>
_____________________
Addressing Concerns About Opioid Use in Hospice
Some families are hesitant about opioid use due to concerns about addiction or hastened death. IOn hospice, these fears are generally unfounded:
Addiction is not a concern in patients with a terminal diagnosis and limited life expectancy.
Properly administered opioids do not hasten death. In fact, research shows patients often live longer when their symptoms are well managed.
Medications are started at low doses and increased gradually, with careful monitoring by the care team.
Changes in breathing pattern or increased discomfort is usually a result of disease progression, not medication side effects.
If you live in South Jersey and have questions about hospice pain management
for your loved one, please call Samaritan at (856) 596-1600.
Emotional and Spiritual Support
Physical pain is closely linked to emotional and spiritual distress. Hospice care includes visits from trained:
- Social workers, who provide counseling and support
- Chaplains (Spiritual Support Counselors), who offer spiritual guidance and comfort as requested
Medications like Ativan (lorazepam) or Valium (diazepam) may also be used to manage emotional symptoms such as anxiety.
Families are encouraged to foster a peaceful environment, avoiding arguments or distressing conversations around the patient.
Complementary Therapies for Hospice Pain Management
In addition to medications, hospice often uses non-medical complementary therapies to ease discomfort and enhance well-being.
1. Massage Therapy
Gentle massage can reduce:
- Pain
- Swelling
- Emotional distress
- Nausea
- Anxiety
- Stiffness and restlessness
Massage also improves circulation, lowers blood pressure, and increases comfort. Family members can even learn simple techniques to connect with their loved one through physical touch.
“Massage can be a wonderful way for family members to connect with their loved one. It can provide peace and comfort toward the end of life,” says Dr. Goldfine.
2. Music Therapy
Music therapy helps patients:
- Reduce pain and anxiety
- Recall positive memories
- Express emotions
- Strengthen connections with loved ones
Sessions may include listening, singing, moving, or even creating music together.
3. Pet Therapy
- Reduce pain and stress
- Improve overall comfort
- Lower blood pressure
- Improve heart rate
- Encourage laughter and conversation
- Trigger release of feel-good hormones
4. Aromatherapy
At Samaritan, commonly oils include:
- Lavender is used for restlessness, insomnia, nervousness, and depression. It is also used for digestive issues, including upset stomach, nausea, loss of appetite, and intestinal gas (flatulence).
- Orange oil is used to relieve symptoms associated with anxiety and depression. .
Questions? We’re Here to Help
If you live in South Jersey and have questions about pain management in hospice, please call Samaritan at (856) 596-1600 or contact us online. Our compassionate team is ready to guide and support you.