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Assessment/Management of Pain in the Very Last Days of Life
  1. Michelle Morris, Liverpool Care Pathway Facilitator
  1. Guy’s and St Thomas’ NHS Foundation Trust, London. Email: michelle.morris{at}


This article discusses the holistic pain assessment and management of a 63-year-old man with end-stage pancreatic cancer who was admitted to a large, inner-city, teaching hospital. The author works as a Liverpool Care Pathway (LCP) facilitator, offering support and education to front-line staff. She has found that staff lack education and skills in pain management, most notably at the end of life. In particular, staff are not aware of the concept of total pain and how patients’ spiritual, psychological and social needs can lower their pain thresholds and make pain harder to control. The article uses a case scenario to highlight how the ‘total pain’ of a semi-conscious, dying man was assessed and treated. It highlights the need for good communication skills and the importance of including the patient’s family in the assessment. The wider implications for palliative care nursing are described. All names have been changed to protect client and family confidentiality, in accordance with Nursing and Midwifery Council (2008) guidelines. Conflicts of interest: none

  • End-of-life care
  • Nursing role
  • Pain assessment and management
  • Total pain

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