Becoming an End-of-Life Companion, Part 7: Pain

Day 8 of our training focused on managing pain at the end of life. An experienced palliative care doctor shared some basic knowledge about pain with us, along with her own experience treating people, both at the hospice and at home. I have to admit this was by far the most challenging session so far, and even though I'm not sharing everything she told us, I want to flag that some of what follows can be distressing.

Here's what I took away.

❧ Pain is multidimensional
We'd already come across the concept of total pain, the idea that pain isn't only physical but also emotional, social, and spiritual. How someone experiences pain depends not just on its physical nature, but also on their emotional, social, and spiritual state.

❧ The fear of opioids runs deep
Many people refuse opioids out of fear of becoming addicted, even though addiction obviously isn't much of a concern for someone who won't live long enough to face its consequences.

❧ A balance between pain and consciousness
As pain increases, a patient may eventually need to choose between tolerating a certain level of pain or losing some of their consciousness.

❧ Most people slip away in their sleep
The doctor told us that around 90 percent of her patients die of exhaustion, simply falling asleep and not waking up. I find that quite comforting, honestly.

❧ The difficult topic of palliative sedation
Palliative sedation means sedating a patient so heavily that it may accelerate the dying process. It's a last resort, used when a patient's symptoms become unmanageable and their suffering intolerable. Because its purpose is to relieve distress, not to end life, it isn't considered euthanasia. Still, when and whether to use it remains deeply controversial, especially once the patient is no longer conscious enough to express their own wishes.

Palliative sedation is never an easy decision. And even without it, a patient's death can sometimes be unintentionally hastened by pain medication, which can put the palliative care team in an incredibly difficult position if a grieving family suspects something closer to harm than care.

How people die matters. So let's have compassion for those who do their very best to ease pain for people at the end of life.