Managing pain and other symptoms

Managing symptoms, including pain, is an important part of end of life care.

Each person will have different symptoms, depending on their condition and the kind of treatment they may be having. Symptoms can include nausea and vomiting, constipation, loss of appetite, and pain.

Your doctor and nurses will manage your symptoms and help you to feel as comfortable as possible.

You can read this whole article or click on the links below to go straight to the relevant section:

Pain

How is medication given?

Nausea and vomiting

Constipation

Loss of appetite

Other methods of symptom management

Pain

Not everyone approaching the end of life has pain, but if you do, your doctor or nurse will assess it and decide on a suitable drug and the correct dose to manage it.

They will ask you (or your family or carers, if you are not able to communicate) questions about the pain. These might include:

• where it is located
• when it started
• the effect it is having on you – for example, whether it is stopping you from sleeping

The doctor or nurse will sometimes ask the palliative care team to advise them. Pain-relieving drugs are available at home, in hospital, in a hospice, and in a care home.

Your doctor or nurse will use the weakest painkiller available that keeps you free from pain. In order of strength (starting with the weakest) there are non-opioid painkillers, such as paracetamol; then mild opioids, such as codeine; and strong opioids, such as morphine.

An opioid is a chemical that works by binding to special opioid receptors in the body (found mostly in the central nervous system and gut), which reduces the pain we feel.

How is medication given?

You will usually be given drugs in the least invasive way possible. This means they will be given in a way that causes the least amount of discomfort, pain or distress.

The first step is to take them by mouth (orally). If this is not possible – for example, if you are vomiting or cannot swallow – painkillers can be given:

• through an injection under the skin (subcutaneous)
• through an injection into the muscle (intramuscular)
• directly into a vein (intravenous)

Sometimes a small, battery-operated pump called a syringe driver is used to give medication continuously under the skin for a period of time, such as 24 hours. You might be offered a syringe driver if you cannot take medication by mouth – for example, if you are being sick or have difficulty swallowing.

There are also some strong painkillers that can be given through a patch on the skin.

Sometimes supplementary (adjuvant) painkillers are used alongside non-opioid and opioid painkillers. Adjuvants include medicines that are designed for other conditions, such as epilepsy, but work well with certain types of pain.

Some drugs can have side effects, such as making you feel drowsy or sick. Talk to your doctor, nurse or palliative care team, who can help with managing these side effects.

Macmillan Cancer Support has useful information on describing your pain. This can help your doctor or nurse to understand the kind of pain you are feeling, and work out the best way of treating it. The information is written for people who have cancer, but is relevant for anybody who is experiencing pain.

Nausea and vomiting

Your condition or medication may make you feel sick or vomit. There is anti-sickness medication that you can take, so talk to your doctor or nurse if you are feeling sick or being sick.

You can also try some self-help techniques that may help you to feel less sick, such as:

• eating small amounts often, rather than trying to eat large meals
• eating dry, carbohydrate food, such as toast or crackers

Some people find that ginger helps, such as ginger tea (you can buy ginger tea, or make it by adding peeled, fresh ginger root to hot water), stem ginger, ginger beer, or ginger added to food.

Constipation

Constipation can be a side effect of some medications, and can also happen if you are not eating and drinking as much as usual. Your doctor can prescribe laxative medication to help with this, so tell your doctor or nurse if you are suffering from constipation.

If you are able to, you can try some self-help techniques, such as:

• eating high-fibre foods, such as brown rice, wholewheat pasta and bread, fruit and vegetables
• drinking as much fluid as you can

Loss of appetite

You may not feel like eating much, and this could be because of your condition or medication. Try to eat small amounts. It might be helpful to have snacks nearby.

As you near the end of life, your body may not be able to digest food as well as it has in the past. At this stage, do not force yourself to eat if you don’t want to.

Your doctor or nurse can discuss your appetite with you, and talk about how much you should be trying to eat. This information can be helpful for your family and carers too, as they may be worried if they feel you are not eating enough.

If your partner, friends or carers want to find out about caring for someone, they can read the NHS Choices care and support guide.

Other methods of symptom management

There are ways of managing pain and other symptoms without using drugs. These include physiotherapy and complementary therapy.

Physiotherapy, often referred to as physio, uses physical methods such as exercise and manipulation to promote healing and wellbeing.

Some people find that complementary therapy, such as massage or reflexology, can help them to feel more relaxed. Many hospices offer complementary therapies.

You can talk to your doctor or nurse about the kinds of pain management that might be available to you. Always tell your doctor or nurse if you're using any complementary therapies.

Other people's experiences and help for carers

Healthtalk.org has videos and written interviews of people talking about their experience of pain and pain control in end of life care.

Read Marie Curie information on helping someone take their medication and syringe drivers. Marie Curie also has guidance on helping someone to relax.

The National Institute for Health and Care Excellence (NICE) has produced new guidance for the care of adults in the last two to three days of life. The guidance covers how to manage common symptoms, and dignity and respect for the dying person and their relatives and carers.