Palliative care - managing pain

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses and a limited life span.

Pain that is always or almost always present can lead to lack of sleep, depression, or anxiety. These can make it harder to do things or go places, and harder to enjoy life. Pain can be stressful for you and your family. But with treatment, pain can be managed.

First, your provider will find out:

• What is causing the pain
• How much pain you have
• What your pain feels like
• What makes your pain worse
• What makes your pain better
• When or in what situations you have pain

You can tell your provider how much pain you have by measuring it on a scale from 0 (no pain) to 10 (the worst pain possible). You choose the number that describes how much pain you have now. You can do this before and after treatments, so you and your health care team can tell how well your treatment works.

There are many treatments for pain. Which treatment is best for you depends on the cause and amount of your pain. Several treatments may be used at the same time for the best pain relief. These include:

• Thinking about something else so you are not thinking about the pain, such as playing a game or watching TV
• Mind-body therapies such as deep breathing, relaxing, or meditation
• Ice packs, heating pads, biofeedback, acupuncture, or massage

You can also take medicines, such as:

• Acetaminophen (Tylenol)
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve), ibuprofen (Advil, Motrin), and diclofenac
• Narcotics (opioids), such as codeine, morphine, oxycodone, or fentanyl
• Medicines that work on the nerves, such as gabapentin or pregabalin

Understand your medicines, how much to take, and when to take them.

• Do not take less or more medicine than prescribed.
• Do not take your medicines more often.
• If you are thinking about not taking a medicine, talk to your provider first. You may need to take a lower dose over time before you can stop safely.

If you have concerns about your pain medicine, talk to your provider.

• If the medicine you take does not relieve your pain, a different one may help.
• Side effects, such as drowsiness, may get better over time.
• Other side effects, such as hard dry stools, may not spontaneously improve but can be treated. It is best to care for these issues before they become a serious problem.

Some people who take narcotics for pain become dependent on them. If you are concerned about this, talk to your provider.

Contact your provider if your pain is not well controlled or if you have side effects from your pain treatments.

End of life - pain management; Hospice - pain management

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

Nabati L, Abrahm JL. Caring for patients at the end of life. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 51.

Shah AC, Cobert J, Gebauer S. Palliative medicine. In: Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Johnson-Akeju S, Leslie K, eds, Miller's Anesthesia. 10th ed. Philadelphia, PA: Elsevier; 2025:chap 48.

Shreves A, Quest TE. End of life. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap e5.

Updated by: Linda J. Vorvick, MD, Clinical Professor Emeritus, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.