Managing End-of-Life Pain and Suffering Through Palliative Care: A State-of-the-Art Review

Abstract

Context: End-of-life care is essential for managing pain and multidimensional suffering in patients with terminal illnesses. Palliative care is a holistic approach that addresses physical, psychological, social, and spiritual distress to enhance quality of life. Despite advances, challenges persist, including inadequate symptom assessment, limited access to services, and ethical dilemmas, particularly in culturally diverse and resource-limited settings. Evidence Acquisition: A state-of-the-art review methodology was used to synthesize evidence on palliative care practices for managing end-of-life pain and suffering. PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Google Scholar were searched. Studies addressing adult palliative care, pain, suffering, and psychosocial-spiritual dimensions were included. Thematic synthesis identified four key domains: Dimensions of suffering; pain and symptom management; spiritual, existential, and relational care; and ethical, cultural, and system-level challenges. Results: Findings from 59 studies indicate that suffering encompasses physical, emotional, social, and existential distress. Pain was reported in 81% of patients with cancer and in 57% – 69% of patients with non-cancer conditions in their final days. Effective strategies include pharmacological approaches, such as opioids and multimodal analgesia, and non-pharmacological interventions, including dignity therapy and virtual reality. Early integration of palliative care improves outcomes. Spiritual and relational care can foster meaning and resilience; however, cultural taboos and resource inequities limit access. Ethical dilemmas, including sedation, autonomy, and biases in emerging technologies, such as artificial intelligence, further complicate care delivery. Conclusions: Holistic palliative care may help mitigate end-of-life suffering; however, gaps remain regarding nonpharmacological interventions, non-Western cultural contexts, and equitable access. Future research should prioritize inclusive, evidence-based practices and policy reforms to support dignified end-of-life experiences globally.