Nonpharmacologic pain management in terminal care

The elderly, terminally ill patient often experiences physical, emotional, and spiritual pain. While pharmacology remains the cornerstone of pain management, non-pharmacologic methods can serve as adjuncts for pain relief, and also serve to enhance the overall quality of the patient's life. Neurostimulation, such as TENS unit, acupuncture, and massage, are based on the gate theory of pain control. These treatments can be useful particularly in muscular pain. Methods aimed at altering the patient's behavior or mood, such as imagery and aromatherapy, can provide an atmosphere of relaxation and comfort. For those patients with localized, particularly difficult to manage areas of pain, specialized neurolytic or neurosurgical methods are available. It would behoove health care practitioners who deal with pain management in elderly, dying patients to add some of these non-pharmacologic methods to their armamentarium of therapies.