Total Pain:

Cecily Saunders coined the term “Total Pain” to capture the all-encompassing nature of the pain experienced by those with a terminal illness. Psychological, emotional, social, financial, and spiritual pain contribute to the experience of physical pain. Physical pain can be made worse when other sources of pain are not addressed. This is another reason that an interdisciplinary team is so important; team approach allows for whole person treatment.

Pain Management:

Comfort goals are:

  1. First, to be comfortable during the night and to get a good sleep.
  2. Next, to be comfortable during the day while at rest.
  3. Finally, to be comfortable during the day when one is moving around and doing the things that are important to the person.

Mild, Moderate, and Severe Pain

The World Health Organization developed a simple model to guide health professionals in choosing the most appropriate pain medication for the severity of pain being experienced. There are two basic types of pain medicine: non-opioid (for mild pain) and opioid (for moderate and severe pain). Opioids are drugs such as codeine and morphine.

Mild Pain

  • Acetaminophen (Tylenol)
  • Anti-inflammatory drugs, such as Ibuprofen
  • Tylenol #3 (codeine) or MOS (morphine syrup)


  • Codeine
  • Morphine
  • Hydromorphone (Dilaudid)
  • Fentanyl patch

Moderately Severe and Severe Pain

  • Morphine
  • Hydromorphone (Dilaudid)
  • Fentanyl patch
  • Methadone

Other Ways of Managing Pain

Medical: Surgery, Radiation, Chemotherapy, Nerve Blocks

Alternative treatment: Acupuncture, Massage, Healing Touch

Other: Application of Heat/Cold, Positioning, Rest and Relaxation (often music, visualization, listening to stories etc.)

Psychological: Address issues beyond the physical pain (e.g. easing fear, stress, and anxiety through progressive muscle relaxation and mindfulness).