Pain in palliative care


Many people are frightened of pain. However, there are many effective pain medications and other ways of managing pain, so it can usually be controlled. Everyone feels pain differently. Even people with the same condition have very different experiences. It’s important to help your doctors and nurses understand exactly where your pain is, how it feels and how it affects you, so that they can treat it effectively.

Many people believe that they should put off using pain medication for as long as possible, and only take it when their pain gets unbearable. However, if pain is not treated it may become more difficult to control, so it’s important to take any pain medication that you are prescribed in the way that your doctor advises.

Pain medication

There are different types of pain medication for different types of pain. The type of pain management also needs to be matched to how bad the pain is. International guidelines set out the types of pain medication that are most effective for different levels of pain. This is known as the analgesic ladder. It recommends specific types of pain management for mild, moderate and severe pain.

  • mild pain – mild pain medication or anti-inflammatory drugs, for example paracetamol or ibuprofen
  • moderate pain – weak opioid pain medication such as codeine
  • severe pain – strong opioid pain medication, for example morphine

For some types of pain you may be given other types of drugs to take as well as your pain medication. Anti-inflammatory drugs, antidepressants, anticonvulsants (usually used to treat epilepsy) and muscle relaxants can all help with different types of pain.

If you have frequent or constant pain it’s important to take pain medication regularly. Each dose of pain medication should be enough to manage your pain right through to the next dose. If the pain comes back before your next dose is due, let your doctor or nurse know so they can give you a more effective dose or drug. It may take a few days to get the drugs and doses right, so be willing to persevere and let your doctor or nurse know if the pain is not manageable. Some people find it helpful to keep a diary recording when they get pain.

Side effects of pain medication

Strong pain medications have three common side effects – drowsiness, sickness and constipation. The drowsiness usually wears off after a few days, so it should be possible for you to manage your pain while still being alert enough to do all that you want to do.

If you feel sick, anti-sickness pills can help, and the sickness usually settles gradually over a few days. If you have sickness that doesn’t settle after 7 days, let your doctor know. Changing to another strong pain medication may help stop the sickness.

Constipation is such a common side effect that everyone taking strong pain medication should take a laxative regularly. Many people need to take one which softens the stools and one which stimulates the bowel. Ask your doctor, nurse or pharmacist for advice. Don’t be afraid to vary the dose of your laxatives to keep your bowels moving easily.

Taking pain medication

Most pain medications are available as liquid medicines. You can use these if you have problems with swallowing tablets. Some pain medication can be given as a patch stuck onto the skin. If you can’t swallow, or if you’re drowsy or confused and don’t want to swallow tablets or liquid medicines, the medication can be given through a tiny tube inserted just under the skin of the tummy or arm. Enough pain medication for 24 hours is made up and a small portable pump (a syringe driver) is used to give a continuous dose of the drug. The pump is set up by a doctor or nurse.

A syringe driver is very easy to set up. If you’re able to move around and walk, the syringe driver can be carried in a special holster or a pocket. If you are in bed, then it can be put on the bedside table or tucked under a pillow. Other medicines, for example to treat sickness, can also be given by the syringe driver.

Pain medication and addiction

Many people with a serious illness ask if they will become addicted to drugs such as morphine, or if the medication will make them confused and unable to look after themselves. The answer is ‘no’. People who become addicted to drugs initially choose to take them, and then keep taking them because they have a psychological need for them. This is very different to someone who has a serious illness, is in pain, and needs to keep taking the drug to keep their pain under control. People in pain have a physical need to take the drug rather than a psychological need.

Someone with a serious illness shouldn’t worry about becoming addicted to pain medication such as morphine.

The dose you take will be carefully tailored to your own needs and will only be increased if your pain gets worse. The right dose is the dose that manages your pain effectively. Many people stay on the same dose of morphine for many months. However, it can be harmful to stop taking morphine suddenly. If your pain is relieved by some other treatment, for example radiotherapy, the dose can be gradually reduced under the supervision of your doctor or nurse.

Emotional effects

Strong feelings or emotions such as fear, anxiety, depression and tiredness can make your pain worse. But this doesn’t mean that pain is ‘all in the mind’. Symptoms of many physical illnesses, including asthma, heart disease and stomach ulcers, can be made worse by emotional upset. So, it’s important to try to treat the emotional as well as the physical causes of your pain.

Learning to relax and get rid of some of your fears and anxieties, if only for short periods of time each day, can play a very useful part in controlling pain. You can relax by becoming aware of different groups of muscles around your body and learning to relax them so that you can do this consciously when you are under stress or in pain.

Visualisation or guided imagery helps you to bring happy relaxed pictures into your mind. These can help distract you and overcome some of your pain. Massage with soothing aromatherapy oils can also help you relax.

Last updated:
22 May 2024