Signs & Symptoms of Pain at End of Life

If you or your loved one has a terminal illness, managing your pain is a high priority. Pain can be many things to many people; it can be described in many ways. People most naturally tend to think of their physical pain, but pain can also be emotional and spiritual.

Physical pain can be caused by many factors, such as swelling, nerve damage or disease progression. Physical pain may present in many ways:

Signs & Symptoms of Physical Pain
  • Frowning
  • Grimacing
  • Appetite changes
  • Poor sleeping
  • Fearful expression
  • Teeth grinding
  • Fidgeting
  • Groaning or moaning
  • Crying
  • Sighing
  • Heavy breathing
  • Decreasing activity
  • Change in gait
  • A loss of function
What is emotional pain?

Emotional pain/suffering can be described as an inner feeling of distress, discomfort or unhappiness. Emotional suffering is very common for people who are seriously ill.

Even for a person who is usually calm and relaxed, as the disease progresses symptoms, such as nervousness, anxiety or confusion, might appear. Feeling frightened, angry, upset or overwhelmed by the condition is common. All kinds of concerns, including health, family, finances or the future, can arise. Feelings of sadness and grief related to losing the ability to be active, as well as drawing closer to the end of life, can occur.

Signs & Symptoms of Emotional Pain:
  • Forgetfulness
  • Poor concentration
  • Dull senses
  • Lethargy
  • Boredom
  • Low productivity
  • Negative attitude
  • Anxiety
  • The ‘blues’
  • Mood swings
  • Anger
  • Bad dreams
  • Irritability
  • Crying spells
  • Nervous laughter
  • Dependency on others
What is spiritual pain?

Some words used to describe pain of the human spirit might include loneliness, feeling separated or abandoned, empty, guilty, fearful or even hopeless. Remember:

These feelings can happen to anyone. When faced with a serious illness, it’s natural to wonder and question at a deep level, regardless of one’s beliefs. This can be a time to explore, listen and be open. It might also be a time to search for meaning, peace, forgiveness or love. This can even be a time of possibility, growth and unexpected joy.

Signs & Symptoms of Spiritual Pain
  • Emptiness
  • Loss of meaning
  • Doubt
  • Martyrdom
  • Loss of direction
  • Cynicism
  • Apathy
  • Abandonment
  • Worry
  • Loss of hope
  • Isolation
  • Distrust
  • “No one cares”
  • Guilt
  • Loss of hope
  • “Why is this happening?”
Communicating Pain

Using a consistent system to describe your pain can be helpful; it can help your hospice team determine if your pain changes over time and if you get adequate relief from your pain medicine and other relief measures. Some words you can use to describe pain include:

  • Sharp
  • Constant
  • Shooting
  • Squeezing
  • Dull
  • Aching
  • Burning
Nonverbal Indicators of Pain

If your loved one can’t communicate, look for the following signs of discomfort and speak on behalf of your loved one to the care team.

  • Tense body language
  • Restlessness
  • Strained facial expressions
  • Sad facial expressions
  • Tearfulness
  • Increased resistance/agitation with movement
  • Increased breathing
  • Shortness of breath
  • Changes in sleeping patterns
  • Loss of appetite
  • Withdrawing from family/others, as well as activities and pastimes
  • Decreased communication
  • Decreased activity because of increased pain with activity
  • Weight gain because of inactivity
  • Rubbing/massaging affected areas
  • Verbalizations or sounds of distress

We always want you to be comfortable. Your Hospice team includes a physician, nurse practitioners, registered nurses, social workers and chaplains who are specially trained to help people with physical, emotional and spiritual pain.

If you or your loved one suffers from a chronic illness and may benefit from a team of professionals who are specially trained to manage pain and provide comfort, please contact us, any time.

About Hospice of the Red River Valley
In 1981, Hospice of the Red River Valley was founded on the belief that everyone deserves access to high-quality end-of-life care. We fulfill our nonprofit mission by providing medical, emotional, personal and spiritual care, as well as grief support to our patients, their families and caregivers during a tender time in life. Our staff helps those we serve experience more meaningful moments through exceptional hospice care, 24 hours a day, 365 days a year, wherever a patient calls home. The organization serves more than 40,000 square miles in North Dakota and Minnesota, including in and around Bismarck, Detroit Lakes, Devils Lake, Fargo, Fergus Falls, Grand Forks, Lisbon, Thief River Falls, Valley City and many more communities. Hospice of the Red River Valley offers round-the-clock availability via phone, prompt response times and same-day admissions, including evenings, weekends and holidays. Contact us anytime at 800-237-4629 or


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