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terminal pain PAINthat results from the end-
stages of disease processes such as cancer, CARDIO-
VASCULAR DISEASE (CVD), and AIDS. Doctors
consider a health condition to be terminal when
the person is likely to live less than six months.
Terminal pain occurs because damage to the tis-
sues and structures of the body is extensive and
widespread. The damage often directly involves
nerves. The pain may have a range of characteris-
tics, from deep and sharp to pervasive and aching
or dull.
Current standards of practice in the United
States call for doctors to prescribe or health-care
providers to administer ANALGESIC MEDICATIONSsuf-
ficient to relieve pain and provide comfort, even
to the point of sedation if that is what is necessary.
Family members may worry that such sedation is
tantamount to euthanasia and hastens death, but
this is not the case. The sedation, when the med-
ication has such an effect, allows the person’s
body to relax more deeply. The resulting sleep
increases comfort. Periods of wakefulness are then
more peaceful. Administration methods such as
implanted catheters and PATIENT CONTROLLED ANAL-
GESIA(PCA) pumps allow the person to regulate the
degree of pain relief.
The amounts of medications, typically NAR-
COTICS, necessary to accomplish this are typically
much higher than conventional dosaging. Doctors
who are not familiar with pain treatment or ter-
minal illness are often concerned such amounts
are too high and risk an life-threatening ADVERSE
REACTIONsuch as depressed respiration (BREATHING)
and HEART RATE. However, recent studies demon-
strate that terminally ill people tolerate these high
doses without the adverse reactions people with
less severe pain might experience. The physiologic
changes that occur in the body with high or per-

sistent levels of pain appear to block the normal

processes that would result in slowed breathing.

Because the body continues to adjust to balance

vital functions, there is no clear OVERDOSEceiling

for narcotics taken to treat severe or terminal

pain. ADDICTION, with its psychologic components,

is not a concern in treatment for most severe pain,

including terminal pain.

Family members who are concerned that their

terminally ill loved ones are not receiving ade-

quate pain relief should discuss this with the

patient’s doctors and other health-care providers

and request consultation with a pain specialist if

concerns continue. Medications and therapies are

readily available to provide relief from terminal

pain.

See also CANCER TREATMENT OPTIONS AND DECI-

SIONS; END OF LIFE CONCERNS.

transcutaneous electrical nerve stimulation

(TENS) A small device that transmits mild elec-

trical impulses through electrodes attached to the

surface of the SKIN above areas of PAIN. The

impulses alter the function of the neurons (noci-

ceptors) responsible for transmitting pain signals

to the CENTRAL NERVOUS SYSTEM. TENS is primarily a

treatment for CHRONIC PAIN such as neck or low

BACK PAINand is most effective for pain that is mild

to moderate in severity. The doctor may suggest

applying the electrodes above trigger points or

major nerves, or along dermatomes, depending on

the path of the pain.

Settings that provide relief are highly individu-

alized and often TENS requires a period of trial

and error before the person finds electrode posi-

tions, impulse intensity and duration, and timing

settings that work. Though it is possible to set the

delivery of electrical impulses at such a level as to

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