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Pain Management at the end of life


Pain management at the end of life care is important to both patients and physicians. Clinicians have a duty to relieve a patient’s pain up to their last moments. It is estimated that about 30% of patients experience severe pain before their end of life and about 25% of patients with chronic diseases die in severe pain. It is therefore important for all parties involved to help patients in pain management. This prevents suffering of the patients themselves and creates a better environment for the patients’ relatives and the health care workers. In spite of the ethical concerns against various methods of end of life pain management, it is the right of each patient to have their pain relieved.

Types of Drugs Used For Pain Management

The most common drugs used for pain management are Analgesics and sedative medications such as opioids. The use of these medications is determined by the severity of pain experienced. Opioids are the most commonly used as most patients experience moderate to severe pain during their end times. Opioids are said to be more effective in handling severe pain and they are easy to manage. However, opioids are associated with certain shortcomings some of which are related to sedatives. The common side effects of opioids include nausea, sedation and pruritus. Proper medical management when using opioids can resolve these side effects. This can be done through dosage variations and use of opioids together with other drugs meant to counter these side effects.

Despite opioids being medically recommended as an effective way to manage severe pain, their use is restricted. Myths are the major cause of limited opioids use to manage severe pain at the end of life. The myths suggest that opioids can result to patient addiction and thus leading to substance abuse. This is due to drug dependence by patients undergoing pain management. For example, some of the medications must be given up to the time of death and must be continuously managed at all times. Another myth associated with opioids is that they lead to an imminent death.

Ethical Issues

Managing pain at the end of life is associated with various ethical issues. These are mainly from the concerns raised on the use of analgesic or sedative medications. The use of sedatives such as opioids hastens the process of death according to some clinicians. This creates a controversy of whether the use of analgesic or sedative is a form of assisted suicide or a form of slow euthanasia. The controversy creates an ethical dilemma between pain control medication to stop patient suffering and ethical considerations on euthanasia. The ethical concerns of euthanasia are however not supported by any medical research. Some professionals argue that the opposite might take place in which a patient may die much earlier from severe pain.

There are various considerations used to resolve ethical issues on end of life pain management. In 1997, the Supreme Court in the U.S. ruled that the use of sedation is appropriate to individuals who are near death. The ruling justified the use of drugs such as opioids if the sole intent is to relieve pain even if their use may result to hastened death. Pain management at the end of life is also supported by the World health Organization (WHO) which states that pain management is a right of every patient.


Caring of patients at their end of life is distressing to all parties involved. Clinicians are faced with decision making challenges as they consider the patient’s suffering and the ethical concerns of the methods of alleviating pain. Most experts argue that sedation is correct regardless of its side effects as the patient is likely die faster without the medication.


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