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Who Reports Having More Pain at the End of Life? FREE

[+] Article and Author Information

The summary below is from the full report titled “The Epidemiology of Pain During the Last 2 Years of Life.” It is in the 2 November 2010 issue of Annals of Internal Medicine (volume 153, pages 563-569). The authors are A.K. Smith, I.S. Cenzer, S.J. Knight, K.A. Puntillo, E. Widera, B.A. Williams, W.J. Boscardin, and K.E. Covinsky.


Ann Intern Med. 2010;153(9):I-30. doi:10.7326/0003-4819-153-9-201011020-00001
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What is the problem and what is known about it so far?

Pain at the end of life is everyone's great fear, but we still do not know enough about what makes pain worse at the end of life. Studies of pain near death have mostly looked at specific types of patients, such as those with cancer or those who are in a hospice program in which a patient's comfort and reducing pain is a main focus of care. Other studies have asked family members about their deceased or dying relative's experience of pain in the last months of life, but these reports are affected by their feelings about the pain of their loved one. In addition, studies have generally not examined patients from national surveys that offer broader understanding of patients' experience of moderate to clinically significant pain at the end of life.

Why did the researchers do this particular study?

The authors used information from a national survey that was conducted every 2 years to find patients who were interviewed within 2 years of death. They looked at 24 groups of patients on the basis of the month before death that they were last interviewed. They studied the proportion of patients who had moderate or severe pain and examined the diseases and patient characteristics that were related to having clinically significant pain.

Who was studied?

This was a national sample of persons who were living in the community and not in institutions, such as nursing homes.

How was the study done?

Patient interviews, conducted mostly by phone, were used. For about 20% of the participants, a family member or friend responded.

What did the researchers find?

Among the more than 4700 patients in the study, about 25% had clinically significant pain. However, the proportion experiencing significant pain increased to nearly 50% in the last 4 months before death. One of the most important things that affected the amount of pain was having arthritis. Surprisingly, the reason that a person was dying, such as heart disease or cancer, was not associated with important differences in the amount of pain.

What were the limitations of the study?

No information about treatment for pain was provided, and the study did not follow specific patients over time to see how their pain changed. Some people with arthritis might have had pain from something else that they mistakenly thought was arthritis.

What are the implications of the study?

Physicians and patients are not good at knowing when death is close, so it is important long before the last few months of life to discuss pain and ways to reduce it. Arthritis may be an important cause of pain or death that could be reduced by lifestyle changes long before death.

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