Why is the pain relief of dying patients often unsuccessful? The relatives' perspectives

In order to determine relatives' opinions of the pain relief of dying patie nts a postal questionnaire was sent to close relatives (n = 371) of aged pa tients (mean age 80.1 years) who had died one to two years earlier. In the relatives opinions, 57% of the patients (n = 211) had suffered from moderat e to severe pain and in 22% (n = 46) of these the pain relief was unsuccess ful. Inadequate pain relief was associated with a feeling of helplessness i n the patients (odds ratio 2.6), insufficient self-determination of analges ic use (9.4), unsatisfactory care of daily needs such as nutrition (8.3), a nd insufficient care of concomitant symptoms such as dry mouth (6.2). The p ain relief was also evaluated as having been unsuccessful when the relative s received limited information about the forthcoming death (5.7), when it w as difficult to discuss with the clinical staff (5.7), and when the relativ es were not supported by, for example, comforting and heartening (7.9) or e ncouraging to participate in the care (7.2). In the multivariate analysis, the self-determination of the patients about their pain medication (5.7), difficulties of the relatives to discuss issue s with the nursing staff (3.7) and poor atmosphere of the treatment environ ment (2.8) emerged as the most significant associates of unsuccessful pain relief. The results show that dissatisfaction with the pain management is associate d with low appreciation of the treatment of other discomforts and complaint s. Successful pain management therefore requires a holistic approach to the wi der spectrum of problems in dying patients.