“Pain is what the experiencing person says it is, and exists whenever the experiencing person says it does”

                         (McCaffery and Pasero 1999)

Not all people with life-limiting illness experience pain. For those who do, it is very distressing and can be frightening. Medication can alleviate most pain but there are a small number of people whose pain does not respond well to medicines.

It is estimated that 70-80% of those with advanced life-limiting illness, including cancer and other conditions, experience severe pain. Possible causes of pain include:

• Inflammation caused by infection.
• An illness additional to the main life-limiting condition, e.g.osteoporosis, pressure sores.
• Primary tumour.
• Cancer that spreads (metastases) e.g.to bones.
• Tissue damage as a result of  chemotherapy or radiotherapy.
• Pain can be exacerbated by the psychological,emotional and spiritual impact of the person’s illness – for example, depression, anxiety, insomnia.
• Damage as a result of surgery e.g.neuropathic pain from surgical scars.

Dame Cicely Saunders defined Total Pain as comprising of the suffering that encompasses all of a person’s physical, psychological, social and spiritual anguish, as shown in the diagram below.

The way carers respond to the dying person’s pain may influence the pain relief offeredand help or inhibit the dying person from disclosing pain. It is therefore important to recognise that each individual reacts to pain in different ways. Some dying people may need help to come to terms with pain. Others, particularly Hindus and Buddhists, may choose to endure it because of their religious beliefs. Others may express feelings of pain or distress out loud – for example when mpraying.

Carers should not wait for complaints of pain but enquire regularly as well as observe patients in pain. Clues lie in which medicines have failed, whether sleep isdisturbed, behaviours change and whether activity is limited. Friends and carers can also sometimes provideinformation about pain.

The type of medicine your client is taking depends on the severity, cause and type of pain.

Mild pain

• Non-Opioids:Examples are Paracetamol and Ibuprofen

Moderate pain 

• Weak Opioids:Examples are:
  • Codeine Phosphate – this may be given as a combined preparation with Paracetamol or Co-codamol .

Moderate to severe pain 

• Strong opioids.An example is morphine.

Ideally pain medicines should be given by mouth. This is simpler for patients and allows them to retain more control. However, at times this may not be possible because of the person’s inability to swallow, persistent vomiting or bowel obstruction for example and themedicines may need to be given by:

• A patch applied to the skin 
• Suppositories
• A syringe pump

CME T34 SYRINGE PUMP

Scottish Palliative Care Guidelines: Pain management

Marie Curie: Pain relief and common side effects

Macmillan Cancer Support: Side effects and symptoms: Pain

Some elements of this section are summarised and adapted from Macmillan Foundations in Palliative Care (FIPC) materials 2020, published by Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, United Kingdom. © Copyright Macmillan Cancer Support 2020, produced by the Digital Health & Care Innovation Centre (DHI). Macmillan Cancer Support accepts no responsibility for the accuracy of the content, which is based on UK practice and guidelines at the date of UK publication; nor for the context in which the content is published; nor for any adaptations made for local use. The content as published in this app/website is solely the responsibility of the Digital Health & Care Innovation Centre, Inovo Building, 121 George St, Glasgow G1 1RD.