Many fatal diseases cause similar symptoms, including pain, shortness of breath, digestive problems, urinary incontinence, loose skin, and fatigue. Depression, anxiety, confusion, loss of consciousness, and disability may also occur. Symptoms can usually be expected and treated.

The doctor’s choice of pain reliever depends largely on the severity and cause of the pain. The doctor determines this by talking with the person and observing them. Aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs are effective in relieving mild pain. However, many people need more powerful pain relievers, such as opioids, to treat moderate to severe pain. Opioid analgesics given by mouth, such as oxycodone, hydromorphone, morphine, and methadone, or sublingually such as fentanyl, can provide adequate and effective pain relief for several hours. If a person cannot take opioids by mouth or under the tongue, these opioids are given by a skin patch or injection under the skin or into a muscle and through the rectum, or by continuous intravenous infusion.

Adequate drug treatment should be given early rather than left until the pain becomes unbearable. There is no usual dose; Some patients only need small doses, while others require much larger doses to get the same effect. If the opioid dose is no longer effective, doctors must increase the dose, often by doubling it. Dependence or dependence on medications may result from regular use of opioids, but cause no problems in dying people except for the need to avoid sudden withdrawal and its unpleasant symptoms. Drug addiction is simply not a concern when a person is about to die.

However, opioids may cause side effects, such as nausea, sedation, confusion, constipation, or slow or shallow breathing (respiratory depression). Most of these side effects, with the exception of constipation, usually go away with time or when an opioid is replaced by another. Often, constipation can be reduced by starting with laxatives even before opioids are given. Opioids can sometimes cause delirium and seizures. But people who have severe or persistent side effects or insufficient pain relief often benefit from treatment by a pain specialist.

Use of other drugs in addition to opioids often increases comfort and reduces opioid doses and side effects. Corticosteroids (such as prednisone or methylprednisolone) can reduce inflammation and swelling pain. Antidepressants (such as nortriptyline and doxepin) or gabapentin also help manage pain caused by problems with the nerves, spinal cord, or brain. Some antidepressants, such as doxepin, may also be given at night to help people sleep. Benzodiazepines (such as lorazepam) are helpful for people whose pain is made worse by anxiety.

For severe pain in one spot, a local anesthetic injected into or around a nerve (“nerve block”) by an anesthesiologist (a doctor with special training in managing pain and supporting people during surgery) may provide little pain relief. of side effects.