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Pain assessment and management in the last weeks of life

Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN
Russell K Portenoy, MD
Section Editor
Janet Abrahm, MD
Deputy Editor
Diane MF Savarese, MD


Most people die after a period of deterioration caused by one or more chronic progressive illnesses. The suffering that characterizes the period before death can be related, at least in part, to the experience of unrelieved symptoms.

Pain is among the most prevalent of these symptoms. When pain is unrelieved, it can be a source of great distress. This distress not only can affect the patient but also may extend to family caregivers, who may experience guilt, anger directed at medical personnel, or regret that persists long into the future. The care of patients with unrelieved pain also may adversely affect professional caregivers, potentially increasing the risk of burnout.

The proper management of pain at the end of life is imperative and the necessary analgesic interventions are well within the purview of primary care providers. All clinicians who care for the chronically ill should acquire basic skills in pain management.

The assessment and management of pain in the last weeks of life are discussed here. The ethical issues surrounding pain control at the end of life, management of symptoms, including pain, in the last hours to days of life, and control of other symptoms in patients in the last days to weeks of life are discussed elsewhere. (See "Ethical considerations in effective pain management at the end of life" and "Overview of managing common non-pain symptoms in palliative care" and "Palliative care: The last hours and days of life" and "Palliative sedation".)


Pain is widely prevalent in the last weeks of life regardless of the setting in which patients are being managed. As an example, one estimate suggests that at least one-fifth of the million patients who die in hospitals each year experienced pain during the final admission [1]. Similarly, a survey of hospice patients in nursing homes found that about 50 percent had daily pain, which was moderate or worse in about 85 percent [2]. A nationally representative longitudinal survey of community-dwelling United States residents found a prevalence of pain in the last year of life ranging from 54.3 to 60.8 percent (CI 58.2-63.4%), with a steady trend upward from 1998 through 2010 [3].  


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Literature review current through: Sep 2016. | This topic last updated: Oct 23, 2015.
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