Pain and Fear of Death

Pain expert Dr. Scott Fishman answers questions about end of life pain:

Q: How does fear of death affect pain at the end of life?

A: Pain at the end of life is inescapably interwoven with, and often amplified by, multiple levels of emotional and spiritual angst as the inevitability of death looms. Fear, a potent pain magnifier, is the dominant emotion - fear of pain, fear of death, fear of the unknown.

It is commonly believed that people at the end of life fear pain even more than they fear death. Sadly, for many dying patients, pain seems like the ultimate torment, and death is its cure. It does not have to be this way, and if you or a loved one is facing death, you have every right to ask that your final days not be consumed by pain.

Fear is just one of the powerful emotions in the mix. Dying patients are often prey to a host of anxieties about the state of their affairs, about the fate of those who will grieve their loss, and about how their behavior will be seen, and possibly judged, during their final hours. And of course, there are often deep spiritual and religious questions to address. Did my life have meaning? Will my soul survive my body? Am I at peace with myself, my family, and my friends?

Not least of all these concerns, people at the end of life worry about how their pain will be managed. Will they be under medicated and have to ask, or even beg for relief? Will they be overmedicated and lose consciousness during their precious waning days and hours?

They may even be afraid to complain. If they do, will they be seen as whiners or quitters? If they ask for narcotics, will they be judged by their doctors as drug seeking, or even cowardly? Or will their medical care be relegated to comfort measures only, while all efforts to cure their illness are suspended?

One of the most universal fears is dying alone or being emotionally abandoned. Whether from a feeling of helplessness or aversion, caregivers may spend less time with someone who is dying or neglect to offer simple human comfort, like holding someone's hand or sitting with them for a moment. Dying patients who sense reluctance and avoidance feel abandoned and rejected. The cloud of imminent death casts a shadow of abandonment at a time when a person needs to feel connected and loved.