Unrelieved pain is one of the most common causes of somatic, psychological, and spiritual distress in the months, weeks, and days before death. In addition to wanting to preserve as much quality of life as possible, most patients at the end of life prefer to die elsewhere rather than the hospital. Achieving this goal requires adequate pain control. The relief of pain at the end of life is a priority for patients, family members, caregivers, and healthcare professionals, yet it continues to be under recognized and undertreated or untreated (Brennan, Carr, & Cousins, 2007; Reynolds, Drew, & Dunwoody, 2013; Groninger & Vijayan, 2014; Ripamonti, Santini, Maranzano, Berti, & Roila, 2013).
In the poorest and most socially dysfunctional developing nations, pain at the end of life is widely ignored despite the widespread suffering from causes such as human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), poverty, oppression, violence, and war and its aftermath (such as land mines). In developing countries, the gap between recognizing the importance of pain management at the end of life and effectively treating it has resulted in numerous declarations underlining the fact that pain is being inadequately addressed for many cultural, attitudinal, educational, political, religious, and logistical reasons. Yet the problem of unrelieved or inadequately treated pain persists, resulting in enormous physiological, psychological, economic, and social consequences for patients, families, and communities (Brennan, Carr, & Cousins, 2007).
Failure to achieve effective pain relief has profound outcomes, including tremendous suffering for patients, a sense of failure by family and caregivers, and distress among professionals who understand that the goal of a peaceful death is based on a foundation of effective pain relief (Ferrell, 2010).
The field of pain management has advanced tremendously over the past 20 years and is supported by evidence-based guidelines for practice. Thus, effective and compassionate pain relief at the end of life should no longer be an issue of concern. When healthcare providers are knowledgeable and centrally involved in patient education about medications, the management of adverse side effects, nonpharmacologic pain management options, and the evaluation of the patient’s response to pain relief options, everyone benefits (Ferrell, 2010).
The careful assessment of pain is the vital first step in effectively managing pain at the end of life (Ripamonti, et al., 2013). This assessment is essential at every stage of the patient’s disease to determine the underlying cause(s) of pain and select appropriate pain relief treatments. In end-stage disease, it is a common mistake to assume that a comprehensive pain assessment is no longer needed and that worsening pain is due only to the advancement of the disease. This is not true, and ongoing assessments are critical to providing the patient with effective pain relief (Ferrell, 2010; Groninger & Vijayan, 2014).
Clients with advanced cancer are more likely to be assessed and treated for potential pain as they near death than are clients with a history of nonmalignant pain. Yet, it is imperative that all clients near death are assessed and treated for pain, regardless of diagnosis.