End of life care - 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 feeling and being sick, constipation, loss of appetite and pain.

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

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

Theyll ask you (or your family or carers, if youre not able to communicate) questions about the pain.

These might include:

• where the pain is


• when it started


• the effect its having on you – for example, whether its stopping you sleeping

The doctor or nurse will sometimes ask the palliative care team to advise them. Pain-relieving medicine is available at home and in hospitals, hospices and care homes.

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


• mild opioids, such as codeine


• strong opioids, such as morphine

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

Youll usually be given medicines in the least invasive way possible. This means theyll 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 taking medicine by mouth is not possible, for example if youre being sick or cannot swallow, you can have painkillers:

• 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 medicine continuously under the skin for a period of time, such as 24 hours.

You might be offered a syringe driver if you cannot take medicine by mouth – for example, if youre 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 designed for other conditions, such as epilepsy, but work well with certain types of pain, such as nerve pain.

Side effects

Some medicines 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 understand the kind of pain youre feeling and work out the best way of treating it.

The information is written for people who have cancer, but is relevant for anybody whos in pain.

Your condition or medicine may make you feel sick or be sick (vomit). Theres anti-sickness medicine you can take, so talk to your doctor or nurse if youre feeling sick or being sick.

It may also help to:

• try eating small amounts often, rather than trying to eat large meals


• try eating dry carbohydrate foods, 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 can be a side effect of some medicines, and can also happen if youre not eating and drinking as much as usual.

Your doctor can prescribe laxative medicine to help with this, so tell your doctor or nurse if youre suffering from constipation.

If youre able to, you can try to help yourself by:

• eating high-fibre foods, such as brown rice, wholewheat pasta and bread, and fruit and vegetables


• drinking as much fluid as you can

You may not feel like eating much, and this could be because of your condition or medicines youre taking.

Try to eat small amounts. It might be helpful to have snacks nearby so you can graze, rather than having full meals.

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 do not want to. Little and often of whatever you fancy can be the best approach to take.

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 youre not eating enough.

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

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

Physiotherapy, or physio, uses physical methods such as exercise and manipulation to promote healing and wellbeing. It can also teach you exercises that help you cope with breathlessness.

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

You can talk to your doctor or nurse about the kinds of treatments to help your symptoms that might be available to you. Always tell your doctor or nurse if youre using any complementary therapies.

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

Marie Curie has information on:

• helping someone take their medicine


• syringe drivers


• helping someone relax


• help and support at the end of life

The National Institute for Health and Care Excellence (NICE) has produced guidance for the care of dying adults in the last days of life.

It covers how to manage common symptoms, and dignity and respect for the dying person and their relatives and carers.

The Dying Matters website offers leaflets on:

• Planning for your future care (PDF, 393kb)


• What to expect when someone close to you is dying

You can read more about:

• advance statement about your wishes


• coping with a terminal illness