by Anna Beck, CNS Hospice Medical Director
As a hospice medical director, I often remind patients and families that pain is not just physical — it touches the emotional, spiritual, and social dimensions of life. September, Pain Awareness Month, gives us an opportunity to highlight how hospice care addresses pain from every angle, with the entire team working together.
Cancer-Related Pain in Hospice
For patients with advanced cancer, pain may be intense, unpredictable, and layered. Addressing it often requires:
- Medications, including opioids for severe pain, balanced with adjuvant drugs tailored for nerve pain or bone pain.
- Rapid reassessment, since cancer pain may escalate quickly and needs vigilant monitoring.
- Team collaboration, where the physician and nurse adjust medications while aides, social workers, and chaplains provide comfort and reassurance.
Chronic Pain Beyond the Hospice Diagnosis
Many patients also live with long-standing conditions like arthritis, spinal stenosis, or neuropathy. These pains may not respond well to opioids and instead benefit from:
- Non-opioid medications, including acetaminophen, topicals, or antidepressants/anticonvulsants.
- Practical support, such as hospice aides helping with positioning, mobility, and comfort measures.
- Integrative practices, like mindfulness, breathing techniques, or prayer, guided by chaplains and social workers.
- Reframing goals, since management shifts from eliminating pain entirely to restoring comfort, sleep, and quality of life.
Not All Pain Is Opioid-Responsive
It’s critical to recognize that not every type of pain improves with opioids. Nerve pain, spiritual suffering, grief, and anxiety-driven physical tension often require different tools. This is where the strength of the interdisciplinary hospice team becomes invaluable:
- Physicians and nurse practitioners lead medication management and ensure the right drug strategies are in place.
- Nurses provide ongoing assessment, coaching on safe medication use, and hands-on comfort.
- Social workers help patients and families navigate the emotional burden of pain and build coping strategies.
- Chaplains address spiritual distress, which can intensify physical pain, by offering presence, prayer, or rituals of meaning.
- Hospice aides ensure that daily routines—from bathing to repositioning—are performed in ways that reduce discomfort.
- Volunteers provide companionship, respite, and distraction, which can ease the weight of both physical and emotional pain.
Shared Principles for All Types of Pain
Listen first: patients’ descriptions guide the treatment plan.- Treat the whole person: blending physical, emotional, and spiritual support.
- Adjust often: pain and needs change, requiring flexibility and responsiveness.
- Partnership matters: when the team, patient, and family all collaborate, relief is more meaningful and sustainable.
Pain awareness isn’t just about medication. It’s about recognizing suffering in all its forms and mobilizing a full team to bring comfort. At hospice, no one faces pain alone — we face it together.