When you’re considering hospice, one of the most common questions is: Will my loved one — or I — be in pain? This concern is completely natural and is the reason we make pain management and comfort the central focus of end-of-life care at Heart to Heart Hospice. 

To help answer this question, it’s important first to understand what the term “comfort care” means. Comfort care focuses on managing pain and other symptoms, providing support, and ensuring dignity and peace.

What Is Comfort Care?

Comfort care in hospice means using every appropriate tool — from medications to gentle therapies and support — to reduce suffering and maintain comfort. In end‑of‑life care, pain and discomfort are often under‑recognized and undertreated, and clinicians strive for a holistic approach that targets both physical pain and the emotional and psychological distress that can accompany it. This concept, called “total pain,” recognizes the multiple dimensions of suffering that patients can experience when in hospice.  

The goal of comfort care isn’t to extend life or alter an illness’s natural progression, but to relieve the patient’s suffering. With that as the priority, hospice professionals consider each person’s unique experience and tailor the care to address what matters most to the patient and their family.

How Pain is Assessed at the End of Life

Many people worry that the final days will mean ongoing suffering. Pain at the end of life is common, but it doesn’t have to be overwhelming. It can stem from the disease itself, treatments, or even daily activities, and the hospice team is trained to recognize, evaluate, and proactively address it.

Accurate assessment is the cornerstone of effective hospice pain and symptom management because pain presents differently for each individual. There are two main methods used to assess patient pain: self-reporting tools and observational scales.

Self-Reporting Pain Assessment

In hospice, the patient’s voice is central. If a patient can communicate their pain, they are encouraged to share what they feel, when the pain occurs, and how intense it is. This self-report guides the nurse and hospice team in deciding whether medication or other comfort measures are needed.

When a patient can communicate, clinicians listen carefully to the patient’s description of their pain, using a numerical scale — from 0 (no pain) to 10 (worst pain imaginable) — or pictures showing different facial expressions to describe discomfort. A patient’s self-report is considered the most reliable measure of their experience of pain.

Observational Pain Assessment

When a patient cannot clearly express discomfort — for example, due to advanced illness, dementia, or cognitive changes — the hospice team relies on observational assessments along with clinical experience. Family members also play a vital role by noting changes in behavior, facial expressions, or other signs that may indicate pain.

With patients who cannot express their pain, hospice clinicians use behavioral observation tools, such as the FLACC scale. FLACC evaluates five categories: Face, Legs, Activity, Cry, and Consolability. Each category is scored from 0–2, giving a total score that helps the care team understand the level of discomfort. This scale is a validated tool widely used in medical settings when self-report isn’t possible.

Hospice nurses and clinicians regularly assess pain using both self-report and observational tools such as the FLACC. These ongoing evaluations, combined with careful listening to the patient and observations from the family, guide decisions on when to administer medication or implement other comfort measures.

Who Decides When Pain Medicine Is Given?

One of the most common questions families ask is who decides when pain medication should be given — the nurse, the doctor, or the family? The answer is: it’s a team approach, and the patient’s comfort is always the priority.

The hospice nurse makes professional recommendations, but when possible, these suggestions are discussed with the patient and family. 

Together, the team decides:

  • Which medication or comfort measure is most appropriate
  • When it should be given
  • How much is needed

This shared approach ensures pain is treated quickly and effectively, while respecting the patient’s wishes and the family’s observations. Hospice clinicians are trained to balance safety with comfort, so families can feel confident that the care provided is both professional and compassionate.

Medications Used to Relieve Pain in Hospice Care

One of the most common aspects of hospice pain management is the careful use of pain medications, including opioids like morphine.

Why Hospice Nurses May Recommend Morphine

Morphine is often used in hospice and palliative care because it’s effective at relieving moderate to severe pain and can also help ease shortness of breath — a symptom many dying patients experience.

You might hear concerns about morphine or other strong pain medicines, but it’s important to understand:

  • Hospice focuses on comfort first. Strong pain medications relieve suffering, and that’s the priority.
  • Patients in hospice are not being treated long enough to develop true addiction. Addiction involves compulsive use over time; people in hospice are typically expected to live six months or less, which isn’t enough time to develop an addiction the way the word is commonly understood.
  • Needing more medicine doesn’t mean addiction. It may simply mean the body needs more relief as the disease progresses.
  • Side effects are expected and managed. Nausea, sleepiness, or constipation can happen, but hospice clinicians know how to treat these issues while prioritizing the patient’s comfort. 

Hospice may also use medications for breakthrough pain — pain that comes on suddenly — and to manage other symptoms like anxiety or restlessness that often accompany physical discomfort. 

Do Hospice Patients Get Addicted to Pain Medications?

This is one of the most common questions families have.

In hospice care, addiction — defined as a compulsive need to use a drug despite harm — is not the same as dependence, which is the body’s physical adjustment to medication. Hospice patients may develop tolerance or dependence, but true addiction is extremely unlikely given the limited time frame and the goals of hospice care.

The priority of hospice pain management is to minimize suffering — not to worry about long-term dependency. Every medication is carefully monitored and adjusted so that the patient’s comfort comes first.

Beyond Medications — Other Comfort Measures

Comfort care isn’t just about medications. Hospice focuses on whole-person care, addressing physical, emotional, and spiritual needs to keep patients as comfortable as possible. Many non-medication approaches can help ease pain, reduce anxiety, and improve quality of life.

Some examples include:

  • Gentle massage and repositioning: Changing a patient’s position, adjusting pillows for support, or offering a gentle massage can help alleviate muscle tension, relieve pressure points, and reduce discomfort.
  • Heat or cold therapy: Applying a warm compress can relax tight muscles, while cold packs may reduce inflammation or localized pain. 
  • Relaxation techniques and music therapy: Practicing deep breathing exercises, guided imagery, and listening to calming music can help reduce anxiety and perceived pain.
  • Emotional and spiritual support: Engaging hospice social workers, bereavement coordinators, and volunteers can help patients and families process emotions, find meaning, and feel cared for.

These strategies are used alongside medications to provide comprehensive symptom management. Hospice teams tailor these approaches to each patient, observing what brings relief and adjusting care as needs change.

Hospice care is more than treating symptoms; it’s about creating a compassionate environment where patients feel safe, supported, and at ease, even in the final stages of life. If you choose hospice care, it does not mean you are giving up. It’s about shifting focus. Pain management is understanding the whole person and using every appropriate tool to relieve suffering. 

You and your loved one are never alone in this process. At Heart to Heart Hospice, our clinicians, nurses, and support staff are here to guide you, answer your questions, and offer personalized care.. Our goal is to provide dignity, peace, and quality of life to all patients — not to cure the disease, but to ease suffering so you can enjoy more meaningful moments with the people you love.