Pain Management

Pain management is a therapeutic approach in which a specialist works with you to reduce or control ongoing pain — whether from a serious illness, a chronic (long-lasting) condition, or end-of-life care — so that daily life becomes more bearable.

Pain signals travel from the affected part of the body along nerves to the brain, where they are felt as discomfort or suffering. Palliative (comfort-focused) pain management uses a combination of medicines, nerve-blocking techniques, physical therapies, and psychological support to interrupt or reduce those signals at different points in the pathway. The goal is not necessarily to remove all pain, but to reach a level that allows the patient to rest, eat, and spend time with loved ones.

Pain management in palliative care is used when pain is significantly affecting a person's quality of life and cannot be adequately controlled by simple over-the-counter medicines alone. It is suitable for a wide range of serious or life-limiting conditions.

• Cancer pain — including pain caused by tumours pressing on organs, nerves, or bones
• Advanced heart failure, where poor circulation causes chest pain or limb pain
• Chronic lung disease causing severe breathlessness and chest discomfort
• Advanced kidney or liver disease with associated pain and discomfort
• Neurological (nerve-related) conditions such as multiple sclerosis or advanced Parkinson's disease
• AIDS-related pain in late-stage HIV infection
• Painful bone conditions such as advanced osteoporosis (thinning of bones) with fractures
• Post-surgical or wound-related pain in patients who cannot undergo further procedures
• Pain linked to end-of-life care, where comfort and dignity are the primary goals

Pain management in a palliative setting may not be the right approach when the cause of pain can still be treated directly and curative (aimed at curing the disease) treatment is still possible and appropriate. In those situations, the treating team will usually address the underlying condition first. A palliative care team will still often work alongside curative teams to keep the patient comfortable during active treatment.

Because pain management in palliative care uses several different methods — medicines, injections, and sometimes small procedures — the risks depend on which specific treatment is chosen. Your doctor will explain the risks of each option before anything is started.

• Drowsiness or sedation (feeling heavily sleepy), especially when strong pain medicines are first started or the dose is adjusted
• Constipation (difficulty passing stools) — a very common side effect of opioid (strong pain-relieving) medicines, usually managed with additional treatment
• Nausea (feeling sick to the stomach) or vomiting, particularly in the early days of a new medicine
• Confusion or disorientation, more common in elderly or very ill patients
• Dry mouth and reduced appetite
• Itching or skin reactions if medicines are given through a patch or injection
• Infection at the site of an injection or catheter (a thin tube placed in the body to deliver medicine)
• Nerve block (an injection that numbs a specific nerve or group of nerves) complications — including temporary weakness, bruising, or, rarely, incomplete pain relief
• Dependence or tolerance (the body adapting so that higher amounts are needed over time) — this is expected in long-term use and is managed carefully by the palliative care team
• In very rare cases involving procedures near the spine, temporary or persistent numbness or weakness in the legs

Preparation for pain management in palliative care is usually lighter than for a major operation, but it still requires honest and thorough communication between you and your care team. What is needed before any specific treatment will depend on which method the doctor recommends.

Before the first appointment, your care team will usually ask you to do the following:

• Write down or describe your pain as clearly as possible: where it is, what it feels like (burning, stabbing, aching), how long it lasts, what makes it better or worse, and how it affects your sleep and daily activities
• Bring a complete list of all medicines you are currently taking, including herbal supplements and traditional remedies, so that the team can avoid harmful combinations
• Tell the team about any allergies, especially to medicines or anaesthetics (substances that cause numbness or reduce sensation)
• Mention any history of substance use or liver disease, as this affects how the body processes pain medicines
• For procedures involving injections or nerve blocks, you may be asked to stop blood thinners (medicines that prevent clotting) for a few days beforehand — your doctor will advise you specifically
• Fasting (not eating or drinking) is usually only required if a sedative (a medicine that makes you calm or sleepy) will be used during a procedure; your team will tell you the exact timing

Tests that are commonly done before starting or changing a pain management plan include:

• Blood tests to check kidney and liver function, since these organs process medicines
• A review of any existing imaging scans (CT, MRI, or bone scan) to understand the source and location of pain
• An assessment using a standardised pain scale or questionnaire to measure pain severity and its effect on function
• Sometimes, nerve conduction studies (tests that check how well nerves carry electrical signals) if nerve-related pain is suspected

If a specific procedure such as a nerve block is planned, the steps typically follow this order:

• 1. You arrive at the clinic or procedure room and the team reviews your medical history and recent test results.
• 2. A nurse checks your blood pressure, pulse, and temperature.
• 3. If sedation is needed, an intravenous (IV) line — a thin tube placed into a vein in your arm — is inserted.
• 4. You are positioned carefully, usually lying down or sitting, depending on which nerve or area is being targeted.
• 5. The skin over the injection site is cleaned and a local anaesthetic (a numbing medicine applied to a small area) is given first to reduce discomfort.
• 6. Under image guidance — usually ultrasound or X-ray — the specialist places a needle accurately near the targeted nerve or joint.
• 7. The medicine is injected slowly.
• 8. You rest in a monitored area for a period of time before going home or returning to your ward.
• 9. The team asks how you are feeling and checks for any immediate reactions before you leave.

After a pain management session or procedure, the care team will monitor you to make sure you are comfortable and that medicines or techniques are working as intended. Because palliative pain management is usually ongoing rather than a one-time event, aftercare involves regular reassessment and adjustment of your treatment plan over time.

• Monitoring: After any procedure such as a nerve block, you will stay in a recovery or observation area until the team is satisfied that you are stable and that no immediate reaction has occurred.
• Returning home: Most pain management appointments are outpatient visits, meaning you can usually go home the same day. Someone should accompany you, especially if sedation was used.
• Activity: Your doctor will advise whether any specific activity needs to be limited after a procedure — for example, avoiding driving for the rest of that day.
• Wound or injection-site care: If an injection was given, the area may be tender for a day or two. Keep it clean and dry. Tell your team if you notice increasing redness, swelling, warmth, or discharge.
• Medicine adjustment: Pain medicines are often changed over time as your condition and pain level change. Never adjust or stop medicines without guidance from your palliative care team.
• Follow-up appointments: The palliative care team will schedule regular check-ins — often more frequently at first — to assess whether the pain is being controlled well and to adjust the plan if needed.
• Keeping a pain diary: Many teams ask patients to note pain levels, sleep quality, and side effects between appointments so that adjustments can be made quickly.
• Emotional and family support: Palliative care teams usually include or can refer you to counsellors, social workers, or spiritual care providers, because managing serious illness affects the whole family, not just the patient.
• Signs to report immediately: Sudden severe increase in pain, high fever, inability to pass urine, new weakness or numbness in the legs, or confusion should be reported to the care team without delay.