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Do people commonly experience pain near the end of life?

While there is not a clear-cut answer to your question, I will try giving some insight into pain and death. Death is an obvious terminal process that all living organisms must go through. Causes of death can include illness, injury, or "natural death" in which their body reaches a state where it simply gives out.

Each cause of death involves different processes, some of which we have subjective data from the individual and some that we do not. It is rather difficult to know how much, if any pain is experienced during a rapid traumatic death. The same can be said for "natural death". Most knowledge has been gained in areas where individuals can report their experience or we can interpret physiological responses to the death process.

From my experience in both emergency and hospice settings, I can say that most people do experience pain during death during injury and illness processes. Often this pain is overcome by stress and fear which causes a release of endorphins. During a quick death process, this release of endorphins is enough to block pain. During a longer death process, endorphins cease to be released and pain becomes a very real problem.

My first concern as a hospice nurse is always with pain control. Personally, I seek to alleviate all pain. This often results in a semiconscious or unconscious state. With that being said, I do consult with the individual and their loved ones regarding their desire for pain relief and end of life wishes. Some people want to endure the pain so they can spend time with family and find closure. Pain is a very subjective and personal experience. For a person who has a quick onset death, pain may be extreme. For someone who has had a terminal process for an extended period, they may have built a tolerance to the pain, this allows them to cope effectively with the pain and require less intervention. Ultimately, caregivers must understand the needs of the individual and help them to find a balance between pain control and addressing their end of life needs.

Katie Ortlip
Hospice Nursing
 Some people experience practically no pain near the end of life, while some have the potential for a lot. I say "potential" because there is no excuse for someone to suffer in pain at the end of life. People with some advanced cancers may need high doses of narcotics and pain pumps, as well as some of the many other medications available for all types of pain. I've also taken care of people simply dying of heart failure due to old age, who need very little medication. Often times there is some difficulty breathing at the very end, but this can easily be relieved with medication as well.
Audrey K. Chun, MD
Geriatric Medicine
Pain is a commonly reported symptom in the last few years of life, with reports of pain increasing during the final few months, according to research published in the "Annals of Internal Medicine." In the study, just over one quarter of people reported being "troubled" by moderate or severe pain during the two years before they died. At four months before death, that number had doubled.

Many studies have examined pain associated with specific conditions, but this is the first to look at pain prevalence at the end of life and pain's correlation both with terminal diagnoses and other comorbidities such as arthritis. Pain control is one of the most challenging tasks doctors face when providing care for patients toward the end of life. Despite recent advances in the understanding of pain management, pain is often unrecognized, undiagnosed, untreated or undertreated.

For the study, 4,703 people, average age 75, were interviewed within the two years prior to their death. If they confirmed they were experiencing pain, they were asked to rate it as mild, moderate or severe. The findings showed that 26% were troubled by pain during the last two years of their lives. Pain levels remained steady until about four months before death, when participants reported that their pain began to increase. By the last month before death, the proportion of people reporting moderate or severe pain had jumped to 46%.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.