{"id":707925,"date":"2026-06-18T04:34:28","date_gmt":"2026-06-18T02:34:28","guid":{"rendered":"https:\/\/www.dynseo.com\/soulager-la-douleur-en-fin-de-vie-droits-options-et-role-de-lequipe-dynseo\/"},"modified":"2026-06-18T04:36:32","modified_gmt":"2026-06-18T02:36:32","slug":"relieving-pain-at-the-end-of-life-rights-options-and-the-role-of-the-team","status":"publish","type":"post","link":"https:\/\/www.dynseo.com\/en\/relieving-pain-at-the-end-of-life-rights-options-and-the-role-of-the-team\/","title":{"rendered":"Relieving Pain at the End of Life: Rights, Options, and the Role of the Team"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Article HTML&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row admin_label=&#8221;Contenu&#8221; _builder_version=&#8221;4.16&#8243; width=&#8221;100%&#8221; max_width=&#8221;100%&#8221; 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transparent;}\n@media(max-width:600px) {\n.dbi-art-d187f7 .article-hero {padding:50px 16px 0;}\n.dbi-art-d187f7 .container {padding:0 16px;}\n.dbi-art-d187f7 .article-body p {font-size:14px;}\n.dbi-art-d187f7 .outil-grid {grid-template-columns:1fr;}\n.dbi-art-d187f7 .cta-box {padding:30px 20px;}\n.dbi-art-d187f7 .cta-box .cta-buttons {flex-direction:column;max-width:260px;margin:0 auto;}\n.dbi-art-d187f7 .btn-cta-white, .dbi-art-d187f7 .btn-cta-outline {width:100%;text-align:center;}\n.dbi-art-d187f7 .internal-link {flex-direction:column;text-align:center;gap:12px;}\n}<\/p>\n<\/style>\n<p><script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"Article\",\"headline\":\"Soulager la douleur en fin de vie : droits, options et r\u00f4le de l'\u00e9quipe\",\"description\":\"Guide sur la douleur en fin de vie en EHPAD \u2014 \u00e9valuation, morphine, s\u00e9dation, approches non m\u00e9dicamenteuses, droits des r\u00e9sidents.\",\"author\":{\"@type\":\"Organization\",\"name\":\"DYNSEO\",\"url\":\"https:\/\/www.dynseo.com\"},\"publisher\":{\"@type\":\"Organization\",\"name\":\"DYNSEO\"},\"datePublished\":\"2026-03-06\",\"dateModified\":\"2026-03-06\"}<\/script><\/p>\n<div class=\"dbi-art-d187f7\">\n<header class=\"article-hero\">\n<div class=\"article-hero-inner\">\n<nav class=\"article-breadcrumb\">\n      <a href=\"https:\/\/www.dynseo.com\/en\/\">Home<\/a> &rsaquo;<br \/>\n      <a href=\"https:\/\/www.dynseo.com\/en\/healthcare-professionals\/\">Professionals<\/a> &rsaquo;<br \/>\n      Relieving pain at the end of life<br \/>\n    <\/nav>\n<p>    <span class=\"article-category\">&#x1F90D; COMFORT CARE<\/span><\/p>\n<h1>Relieving pain at the end of life&nbsp;: <span class=\"hl\">rights, options<\/span> and the role of the team<\/h1>\n<div class=\"article-meta\">\n      <span>&#x1F4C5; March 2026<\/span><br \/>\n      <span>&#x23F1; 18 min read<\/span><br \/>\n      <span>&#x1F9D1;&#x200D;&#x2695;&#xFE0F; By the DYNSEO team<\/span>\n    <\/div>\n<\/p><\/div>\n<div class=\"article-hero-curve\"><\/div>\n<\/header>\n<div class=\"container\">\n<article class=\"article-body\">\n<div class=\"toc\">\n<h4>&#x1F4D1; Summary<\/h4>\n<ol>\n<li><a href=\"#droit-fondamental\">Untreated pain: an unacceptable avoidable reality<\/a><\/li>\n<li><a href=\"#evaluer\">Assessing pain: tools and methods<\/a><\/li>\n<li><a href=\"#dement-douleur\">Assessing pain in a demented resident<\/a><\/li>\n<li><a href=\"#medicaments\">Analgesic medications at the end of life<\/a><\/li>\n<li><a href=\"#morphine\">Morphine: demystifying to better care<\/a><\/li>\n<li><a href=\"#sedation\">Deep and continuous sedation: what it is<\/a><\/li>\n<li><a href=\"#non-medicamenteux\">Non-drug approaches to relief<\/a><\/li>\n<li><a href=\"#role-soignant\">The caregiver&#8217;s monitoring role<\/a><\/li>\n<li><a href=\"#famille-douleur\">What families can do<\/a><\/li>\n<li><a href=\"#droit\">The right to relief: asserting it<\/a><\/li>\n<\/ol>\n<\/div>\n<pee>Untreated pain at the end of life remains one of the great fears \u2014 and one of the great avoidable realities \u2014 of care in a Nursing home. Repeated studies show that a significant proportion of terminally ill residents suffer from inadequately managed pain. Not due to a lack of therapeutic means \u2014 these exist and are effective \u2014 but due to a lack of training, vigilance, and sometimes therapeutic courage in the face of treatments that are still poorly understood.<\/pee>\n<pee>This guide addresses pain at the end of life head-on \u2014 its realities, its assessment tools, its treatments, the rights that frame it \u2014 to provide caregivers and families with the benchmarks they need to demand and obtain dignified relief.<\/pee>\n<h2 id=\"droit-fondamental\">1. Untreated pain: an unacceptable avoidable reality<\/h2>\n<pee>No one should die in pain in 2026. Therapeutic tools to relieve pain at the end of life are available, effective, and framed by clear rights. French law explicitly recognizes the right to pain relief \u2014 even if the necessary treatments may have the side effect of slightly shortening life. This principle, known as the &#8220;double effect,&#8221; has been established in medical ethics for decades and codified in the Leonetti law.<\/pee>\n<pee>Yet, pain is under-assessed and under-treated in many Nursing homes. The causes are multiple: fear of opioids among some caregivers or doctors, residents who do not complain (either out of resignation or because they can no longer communicate), lack of training on assessment tools suitable for demented individuals, insufficient communication between teams. Identifying these obstacles \u2014 and removing them \u2014 is an absolute priority.<\/pee>\n<div class=\"info-box\">\n  <pee><strong>&#x1F4A1; A right enshrined in law.<\/strong> Article L.1110-5 of the Public Health Code states that \u201c&nbsp;everyone has the right to receive care aimed at relieving their pain. This must be prevented, assessed, taken into account, and treated in all circumstances.&nbsp;\u201d This right applies to all residents, at any stage of their illness, in all facilities \u2014 including Nursing homes.<\/pee>\n<\/div>\n<h2 id=\"evaluer\">2. Assessing pain: tools and methods<\/h2>\n<pee>We can only treat well what we assess well. Pain assessment at the end of life must be regular, systematic, and recorded in the care file \u2014 not just triggered when the resident complains.<\/pee>\n<pee>For residents capable of expressing themselves verbally, the <strong>numerical scale<\/strong> (NS, from 0 to 10) or the <strong>simple verbal scale<\/strong> (no pain \/ mild \/ moderate \/ intense \/ unbearable) are the reference tools. Simple, quick, validated \u2014 they allow for assessment in a few seconds during each care session.<\/pee>\n<pee>The assessment must focus not only on background pain but also on the <strong>pain induced by care<\/strong> \u2014 mobilizations, changes, oral care, personal hygiene \u2014 which are often the most intense and the most overlooked. Pre-emptive analgesic medication before painful care is a simple practice that profoundly changes the resident&#8217;s experience.<\/pee>\n<h2 id=\"dement-douleur\">3. Assessing pain in a demented resident<\/h2>\n<pee>Residents with dementia \u2014 who represent the majority of end-of-life residents in Nursing homes \u2014 cannot always verbalize their pain. This does not mean they do not suffer. It means that specific behavioral observation tools are needed.<\/pee>\n<pee>The <strong>DOLOPLUS-2 scale<\/strong> is the validated reference tool in France for assessing pain in non-communicating elderly subjects. It evaluates 10 behaviors grouped into three dimensions: somatic impact (complaints, pain-relieving positions, protection of painful areas), psychomotor impact (tone disorders, refusal of mobilizations), and psychosocial impact (communication, social life, behavior). A score equal to or greater than 5 out of 30 indicates pain that must be treated.<\/pee>\n<pee>The <strong>ALGOPLUS scale<\/strong> is shorter (5 items) and particularly suitable for assessing acute pain during care in demented elderly subjects. It evaluates the face, gaze, complaints, body attitude, and behavior. A score of 2 or more indicates pain.<\/pee>\n<div class=\"soft-box\">\n  <pee><strong>Behavioral signals to systematically observe:<\/strong> furrowing of the brow, facial tension, teeth grinding, unusual agitation, refusal to mobilize, cries during changes or care, hunched posture or permanent antalgic position, increased irritability, sudden refusal to eat. These signals are not always pain \u2014 but they always deserve to be evaluated as such until proven otherwise.<\/pee>\n<\/div>\n<h2 id=\"medicaments\">4. Pain relief medications at the end of life<\/h2>\n<pee>The pharmacological treatment of pain at the end of life follows a progressive logic, adapted to the intensity of the pain and the resident&#8217;s condition. Pain relief medications are classified into three levels according to the WHO classification.<\/pee>\n<pee>The <strong>level 1<\/strong> includes paracetamol \u2014 often underused despite being effective for mild to moderate pain and well tolerated. Its injectable form is particularly useful at the end of life when the oral route is no longer possible. The <strong>level 2<\/strong> includes weak opioid analgesics (tramadol, codeine) for moderate pain. The <strong>level 3<\/strong> includes morphine and strong opioids for severe pain.<\/pee>\n<pee>At the end of life, the route of administration must be adapted to the resident&#8217;s condition. When swallowing becomes difficult or impossible, subcutaneous, transdermal (morphine or fentanyl patches), or intravenous routes take over. The establishment of a <strong>preventive subcutaneous route<\/strong> \u2014 before the condition deteriorates to the point of making any access impossible \u2014 is a good palliative practice that avoids decisions in emergencies.<\/pee>\n<h2 id=\"morphine\">5. Morphine: demystifying to better care<\/h2>\n<pee>Morphine concentrates the most common fears and resistances \u2014 among families, but also sometimes among caregivers and doctors. These fears have a real cost: residents who suffer unnecessarily because an effective treatment is delayed or underdosed out of fear of unfounded effects.<\/pee>\n<pee>The clinical reality, documented by decades of research in palliative care, is clear: morphine prescribed at an appropriate dose to relieve pain at the end of life <strong>does not hasten death<\/strong>. It relieves. The benefit of pain relief is incomparably greater than the theoretical risk of an effect on lifespan \u2014 which, in well-conducted studies, is not demonstrated.<\/pee>\n<div class=\"famille-box\">\n<div class=\"famille-box-label\">&#x1F46A; What families say \u2014 and what can be replied<\/div>\n<div class=\"famille-box-title\">\u201c&nbsp;I don\u2019t want them to give him morphine, it will put him to sleep forever.&nbsp;\u201d<\/div>\n<pee>This fear is understandable and very common. It deserves a direct and compassionate response \u2014 not a sidestep or minimization.<\/pee>\n<div class=\"soignant-box\">\n<div class=\"soignant-box-title\">&#x2665; What can be said<\/div>\n<pee>\u00ab&nbsp;I understand this concern \u2014 it is very common. What we prescribe is a dose adapted to the pain of your loved one \u2014 no more. At this dose, morphine relieves pain without hastening death. What we cannot accept is to let them suffer when effective treatments exist. Relieving pain is also a way to allow them to be more present, more at peace.&nbsp;\u00bb<\/pee>\n  <\/div>\n<\/div>\n<h2 id=\"sedation\">6. Deep and continuous sedation: what it is<\/h2>\n<pee>Deep and continuous sedation until death is a right recognized by the Claeys-Leonetti law of 2016 for terminally ill patients whose suffering is refractory to all treatments. It consists of administering sedative medications to induce and maintain a state of unconsciousness until death.<\/pee>\n<pee>Deep and continuous sedation is not euthanasia. It does not aim to cause death \u2014 it aims to suppress the consciousness of suffering that no treatment can relieve. Death occurs from the disease, not from the sedative. This ethical and legal distinction is fundamental.<\/pee>\n<pee>It is indicated in specific situations: refractory suffering \u2014 physical, psychological, or existential \u2014 in the terminal phase, or to accompany the cessation of life-sustaining treatment whose cessation would lead to unbearable suffering in the short term. Its implementation involves a collegial medical decision, informing and, if possible, obtaining the consent of the resident or their trusted person, and traceability in the care record.<\/pee>\n<h2 id=\"non-medicamenteux\">7. Non-drug approaches to relief<\/h2>\n<pee>Relief from pain at the end of life is not limited to medications. Non-drug approaches, complementary to treatments, can significantly improve the comfort of the resident \u2014 and are accessible to the entire caregiving team.<\/pee>\n<div class=\"outil-grid\">\n<div class=\"outil-card\">\n<h4>&#x1F91D; Therapeutic touch<\/h4>\n<pee>A gentle, slow, respectful touch \u2014 during care or outside of it \u2014 activates pain regulation mechanisms and reduces anxiety. Hand or foot massage is accessible to all caregivers and appreciated by most residents.<\/pee>\n  <\/div>\n<div class=\"outil-card\">\n<h4>&#x1F3B5; Music therapy<\/h4>\n<pee>Music known and loved by the resident can reduce the perception of pain, decrease agitation, and promote relaxation. A headset or soft speaker in the room \u2014 with their favorite music \u2014 is a simple and valuable care.<\/pee>\n  <\/div>\n<div class=\"outil-card\">\n<h4>&#x1F9D8; Relaxation and breathing<\/h4>\n<pee>For residents who are still conscious and able to cooperate, slow breathing techniques and guided relaxation can reduce the anxious component of pain and improve overall comfort.<\/pee>\n  <\/div>\n<div class=\"outil-card\">\n<h4>&#x1F6CF; Positioning<\/h4>\n<pee>A careful setup with positioning cushions, prevention of pressure points, regular adjustment of position \u2014 are fundamental nursing care that significantly reduces pressure pain.<\/pee>\n  <\/div>\n<div class=\"outil-card\">\n<h4>&#x1F4AC; Presence and voice<\/h4>\n<pee>A calm and familiar voice, gentle words, a caring human presence \u2014 have a documented analgesic effect. Not leaving a painful resident alone in their room is a full prescription of care.<\/pee>\n  <\/div>\n<div class=\"outil-card\">\n<h4>&#x1F4A7; Oral care<\/h4>\n<pee>Dry mouth is a major source of discomfort at the end of life. Regular oral care with moist swabs, glycerin, or cool water applied gently relieves this often underestimated suffering.<\/pee>\n  <\/div>\n<\/div>\n<h2 id=\"role-soignant\">8. The caregiver&#8217;s monitoring role<\/h2>\n<pee>The caregiver who spends the most time with the resident \u2014 often the nursing assistant \u2014 is the first observer of pain. Their monitoring and reporting role is irreplaceable. A caregiver trained to recognize behavioral signs of pain, who systematically notes them in reports and alerts the nurse when something changes \u2014 this caregiver saves their resident from days or weeks of unnecessary suffering.<\/pee>\n<pee>This vigilance must be organized, not left to individual initiative. Clear protocols \u2014 when to assess, with what tool, how to report, when to alert \u2014 are quality care tools that structure this collective vigilance.<\/pee>\n<h2 id=\"famille-douleur\">9. What families can do<\/h2>\n<pee>Families can play a valuable role in monitoring pain \u2014 if they are given the means. Their knowledge of the resident \u2014 their usual expressions of pain, their behaviors when they are suffering, their preferred pain-relieving positions \u2014 is valuable clinical information that caregivers do not always have.<\/pee>\n<pee>Encouraging families to report their observations to the team, showing them the behavioral signs to monitor, explaining how to communicate their concerns \u2014 this actively integrates them into the care. And clearly telling them that their reports will be taken seriously \u2014 not minimized or dismissed with a \u201cit&#8217;s normal at this stage\u201d which would be an unacceptable response.<\/pee>\n<h2 id=\"droit\">10. The right to relief: asserting it<\/h2>\n<pee>If a family believes that their loved one is suffering and that pain is not being adequately managed, they have the right \u2014 and perhaps the duty \u2014 to say so, to repeat it, to request a reassessment. They can ask to meet with the coordinating physician, request the intervention of the mobile palliative care team, or in extreme cases, appeal to the rights defender or an external physician.<\/pee>\n<pee>Untreated suffering at the end of life is not a fatality. It is an avoidable failure that training, vigilance, and therapeutic courage can help prevent. Training teams in the assessment and treatment of pain at the end of life \u2014 this is one of the most concrete investments a Nursing home can make for the dignity of its residents.<\/pee>\n<p><a href=\"https:\/\/www.dynseo.com\/en\/courses\/end-of-life-support-caregiving-approach-and-family-assistance-en\/\" class=\"internal-link\"><\/p>\n<div class=\"internal-link-icon\">&#x1F393;<\/div>\n<div class=\"internal-link-content\">\n<div class=\"internal-link-label\">Certified training<\/div>\n<div class=\"internal-link-title\">End of life: support, caregiving posture, and family support<\/div>\n<div class=\"internal-link-desc\">DYNSEO Qualiopi training \u2014 assessment and treatment of pain, comfort care, palliative sedation. For the entire Nursing home team.<\/div>\n<\/p><\/div>\n<div class=\"internal-link-arrow\">&#x2192;<\/div>\n<p><\/a><\/p>\n<div class=\"cta-box\">\n<h3>&#x1F393; Train your team in pain management at the end of life<\/h3>\n<pee>The DYNSEO training \u201cEnd of life: support, caregiving posture, and family support\u201d covers pain assessment, the DOLOPLUS and ALGOPLUS tools, treatments, and non-drug approaches. Qualiopi certified.<\/pee>\n<div class=\"cta-buttons\">\n    <a href=\"https:\/\/www.dynseo.com\/en\/courses\/end-of-life-support-caregiving-approach-and-family-assistance-en\/\" class=\"btn-cta-white\">&#x1F4CB; View the program<\/a><br \/>\n    <a href=\"https:\/\/www.dynseo.com\/formations\/\" class=\"btn-cta-outline\">All training &#x2192;<\/a>\n  <\/div>\n<\/div>\n<div class=\"article-tags\">\n  <a href=\"#\" class=\"article-tag\">end-of-life pain Nursing home<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">DOLOPLUS ALGOPLUS<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">morphine palliative care<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">deep sedation Claeys-Leonetti<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">pain relief elderly people<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">comfort care Nursing home<\/a><br \/>\n  <a href=\"#\" class=\"article-tag\">DYNSEO training<\/a>\n<\/div>\n<\/article>\n<\/div>\n<\/div>\n<p>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":100456,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"[et_pb_section fb_built=\"1\" admin_label=\"Article HTML\" _builder_version=\"4.16\" custom_padding=\"0px||0px||false|false\" global_colors_info=\"{}\"][et_pb_row admin_label=\"Contenu\" _builder_version=\"4.16\" width=\"100%\" max_width=\"100%\" custom_padding=\"0px||0px||false|false\" global_colors_info=\"{}\"][et_pb_column type=\"4_4\" _builder_version=\"4.16\" global_colors_info=\"{}\"][et_pb_code admin_label=\"HTML import\u00e9\" _builder_version=\"4.16\" global_colors_info=\"{}\"]<style 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class=\"article-hero-inner\">\n    <nav class=\"article-breadcrumb\">\n      <a href=\"https:\/\/www.dynseo.com\/\">Home<\/a> &rsaquo;\n      <a href=\"https:\/\/www.dynseo.com\/professionnels-de-sante\/\">Professionals<\/a> &rsaquo;\n      Relieving pain at the end of life\n    <\/nav>\n    <span class=\"article-category\">&#x1F90D; COMFORT CARE<\/span>\n    <h1>Relieving pain at the end of life&nbsp;: <span class=\"hl\">rights, options<\/span> and the role of the team<\/h1>\n    <div class=\"article-meta\">\n      <span>&#x1F4C5; March 2026<\/span>\n      <span>&#x23F1; 18 min read<\/span>\n      <span>&#x1F9D1;&#x200D;&#x2695;&#xFE0F; By the DYNSEO team<\/span>\n    <\/div>\n  <\/div>\n  <div class=\"article-hero-curve\"><\/div>\n<\/header>\n\n<div class=\"container\">\n<article class=\"article-body\">\n\n<div class=\"toc\">\n  <h4>&#x1F4D1; Summary<\/h4>\n  <ol>\n    <li><a href=\"#droit-fondamental\">Untreated pain: an unacceptable avoidable reality<\/a><\/li>\n    <li><a href=\"#evaluer\">Assessing pain: tools and methods<\/a><\/li>\n    <li><a href=\"#dement-douleur\">Assessing pain in a demented resident<\/a><\/li>\n    <li><a href=\"#medicaments\">Analgesic medications at the end of life<\/a><\/li>\n    <li><a href=\"#morphine\">Morphine: demystifying to better care<\/a><\/li>\n    <li><a href=\"#sedation\">Deep and continuous sedation: what it is<\/a><\/li>\n    <li><a href=\"#non-medicamenteux\">Non-drug approaches to relief<\/a><\/li>\n    <li><a href=\"#role-soignant\">The caregiver's monitoring role<\/a><\/li>\n    <li><a href=\"#famille-douleur\">What families can do<\/a><\/li>\n    <li><a href=\"#droit\">The right to relief: asserting it<\/a><\/li>\n  <\/ol>\n<\/div>\n\n<p>Untreated pain at the end of life remains one of the great fears \u2014 and one of the great avoidable realities \u2014 of care in a Nursing home. Repeated studies show that a significant proportion of terminally ill residents suffer from inadequately managed pain. Not due to a lack of therapeutic means \u2014 these exist and are effective \u2014 but due to a lack of training, vigilance, and sometimes therapeutic courage in the face of treatments that are still poorly understood.<\/p>\n\n<p>This guide addresses pain at the end of life head-on \u2014 its realities, its assessment tools, its treatments, the rights that frame it \u2014 to provide caregivers and families with the benchmarks they need to demand and obtain dignified relief.<\/p>\n\n<h2 id=\"droit-fondamental\">1. Untreated pain: an unacceptable avoidable reality<\/h2>\n\n<p>No one should die in pain in 2026. Therapeutic tools to relieve pain at the end of life are available, effective, and framed by clear rights. French law explicitly recognizes the right to pain relief \u2014 even if the necessary treatments may have the side effect of slightly shortening life. This principle, known as the \"double effect,\" has been established in medical ethics for decades and codified in the Leonetti law.<\/p>\n\n<p>Yet, pain is under-assessed and under-treated in many Nursing homes. The causes are multiple: fear of opioids among some caregivers or doctors, residents who do not complain (either out of resignation or because they can no longer communicate), lack of training on assessment tools suitable for demented individuals, insufficient communication between teams. Identifying these obstacles \u2014 and removing them \u2014 is an absolute priority.<\/p>\n<div class=\"info-box\">\n  <p><strong>&#x1F4A1; A right enshrined in law.<\/strong> Article L.1110-5 of the Public Health Code states that \u201c&nbsp;everyone has the right to receive care aimed at relieving their pain. This must be prevented, assessed, taken into account, and treated in all circumstances.&nbsp;\u201d This right applies to all residents, at any stage of their illness, in all facilities \u2014 including Nursing homes.<\/p>\n<\/div>\n\n<h2 id=\"evaluer\">2. Assessing pain: tools and methods<\/h2>\n\n<p>We can only treat well what we assess well. Pain assessment at the end of life must be regular, systematic, and recorded in the care file \u2014 not just triggered when the resident complains.<\/p>\n\n<p>For residents capable of expressing themselves verbally, the <strong>numerical scale<\/strong> (NS, from 0 to 10) or the <strong>simple verbal scale<\/strong> (no pain \/ mild \/ moderate \/ intense \/ unbearable) are the reference tools. Simple, quick, validated \u2014 they allow for assessment in a few seconds during each care session.<\/p>\n\n<p>The assessment must focus not only on background pain but also on the <strong>pain induced by care<\/strong> \u2014 mobilizations, changes, oral care, personal hygiene \u2014 which are often the most intense and the most overlooked. Pre-emptive analgesic medication before painful care is a simple practice that profoundly changes the resident's experience.<\/p>\n\n<h2 id=\"dement-douleur\">3. Assessing pain in a demented resident<\/h2>\n\n<p>Residents with dementia \u2014 who represent the majority of end-of-life residents in Nursing homes \u2014 cannot always verbalize their pain. This does not mean they do not suffer. It means that specific behavioral observation tools are needed.<\/p>\n\n<p>The <strong>DOLOPLUS-2 scale<\/strong> is the validated reference tool in France for assessing pain in non-communicating elderly subjects. It evaluates 10 behaviors grouped into three dimensions: somatic impact (complaints, pain-relieving positions, protection of painful areas), psychomotor impact (tone disorders, refusal of mobilizations), and psychosocial impact (communication, social life, behavior). A score equal to or greater than 5 out of 30 indicates pain that must be treated.<\/p>\n\n<p>The <strong>ALGOPLUS scale<\/strong> is shorter (5 items) and particularly suitable for assessing acute pain during care in demented elderly subjects. It evaluates the face, gaze, complaints, body attitude, and behavior. A score of 2 or more indicates pain.<\/p>\n<div class=\"soft-box\">\n  <p><strong>Behavioral signals to systematically observe:<\/strong> furrowing of the brow, facial tension, teeth grinding, unusual agitation, refusal to mobilize, cries during changes or care, hunched posture or permanent antalgic position, increased irritability, sudden refusal to eat. These signals are not always pain \u2014 but they always deserve to be evaluated as such until proven otherwise.<\/p>\n<\/div>\n\n<h2 id=\"medicaments\">4. Pain relief medications at the end of life<\/h2>\n\n<p>The pharmacological treatment of pain at the end of life follows a progressive logic, adapted to the intensity of the pain and the resident's condition. Pain relief medications are classified into three levels according to the WHO classification.<\/p>\n\n<p>The <strong>level 1<\/strong> includes paracetamol \u2014 often underused despite being effective for mild to moderate pain and well tolerated. Its injectable form is particularly useful at the end of life when the oral route is no longer possible. The <strong>level 2<\/strong> includes weak opioid analgesics (tramadol, codeine) for moderate pain. The <strong>level 3<\/strong> includes morphine and strong opioids for severe pain.<\/p>\n\n<p>At the end of life, the route of administration must be adapted to the resident's condition. When swallowing becomes difficult or impossible, subcutaneous, transdermal (morphine or fentanyl patches), or intravenous routes take over. The establishment of a <strong>preventive subcutaneous route<\/strong> \u2014 before the condition deteriorates to the point of making any access impossible \u2014 is a good palliative practice that avoids decisions in emergencies.<\/p>\n\n<h2 id=\"morphine\">5. Morphine: demystifying to better care<\/h2>\n\n<p>Morphine concentrates the most common fears and resistances \u2014 among families, but also sometimes among caregivers and doctors. These fears have a real cost: residents who suffer unnecessarily because an effective treatment is delayed or underdosed out of fear of unfounded effects.<\/p>\n\n<p>The clinical reality, documented by decades of research in palliative care, is clear: morphine prescribed at an appropriate dose to relieve pain at the end of life <strong>does not hasten death<\/strong>. It relieves. The benefit of pain relief is incomparably greater than the theoretical risk of an effect on lifespan \u2014 which, in well-conducted studies, is not demonstrated.<\/p>\n\n<div class=\"famille-box\">\n  <div class=\"famille-box-label\">&#x1F46A; What families say \u2014 and what can be replied<\/div>\n  <div class=\"famille-box-title\">\u201c&nbsp;I don\u2019t want them to give him morphine, it will put him to sleep forever.&nbsp;\u201d<\/div>\n  <p>This fear is understandable and very common. It deserves a direct and compassionate response \u2014 not a sidestep or minimization.<\/p>\n  <div class=\"soignant-box\">\n<div class=\"soignant-box-title\">&#x2665; What can be said<\/div>\n    <p>\u00ab&nbsp;I understand this concern \u2014 it is very common. What we prescribe is a dose adapted to the pain of your loved one \u2014 no more. At this dose, morphine relieves pain without hastening death. What we cannot accept is to let them suffer when effective treatments exist. Relieving pain is also a way to allow them to be more present, more at peace.&nbsp;\u00bb<\/p>\n  <\/div>\n<\/div>\n\n<h2 id=\"sedation\">6. Deep and continuous sedation: what it is<\/h2>\n\n<p>Deep and continuous sedation until death is a right recognized by the Claeys-Leonetti law of 2016 for terminally ill patients whose suffering is refractory to all treatments. It consists of administering sedative medications to induce and maintain a state of unconsciousness until death.<\/p>\n\n<p>Deep and continuous sedation is not euthanasia. It does not aim to cause death \u2014 it aims to suppress the consciousness of suffering that no treatment can relieve. Death occurs from the disease, not from the sedative. This ethical and legal distinction is fundamental.<\/p>\n\n<p>It is indicated in specific situations: refractory suffering \u2014 physical, psychological, or existential \u2014 in the terminal phase, or to accompany the cessation of life-sustaining treatment whose cessation would lead to unbearable suffering in the short term. Its implementation involves a collegial medical decision, informing and, if possible, obtaining the consent of the resident or their trusted person, and traceability in the care record.<\/p>\n\n<h2 id=\"non-medicamenteux\">7. Non-drug approaches to relief<\/h2>\n\n<p>Relief from pain at the end of life is not limited to medications. Non-drug approaches, complementary to treatments, can significantly improve the comfort of the resident \u2014 and are accessible to the entire caregiving team.<\/p>\n\n<div class=\"outil-grid\">\n  <div class=\"outil-card\">\n    <h4>&#x1F91D; Therapeutic touch<\/h4>\n    <p>A gentle, slow, respectful touch \u2014 during care or outside of it \u2014 activates pain regulation mechanisms and reduces anxiety. Hand or foot massage is accessible to all caregivers and appreciated by most residents.<\/p>\n  <\/div>\n  <div class=\"outil-card\">\n    <h4>&#x1F3B5; Music therapy<\/h4>\n    <p>Music known and loved by the resident can reduce the perception of pain, decrease agitation, and promote relaxation. A headset or soft speaker in the room \u2014 with their favorite music \u2014 is a simple and valuable care.<\/p>\n  <\/div>\n  <div class=\"outil-card\">\n    <h4>&#x1F9D8; Relaxation and breathing<\/h4>\n    <p>For residents who are still conscious and able to cooperate, slow breathing techniques and guided relaxation can reduce the anxious component of pain and improve overall comfort.<\/p>\n  <\/div>\n  <div class=\"outil-card\">\n    <h4>&#x1F6CF; Positioning<\/h4>\n    <p>A careful setup with positioning cushions, prevention of pressure points, regular adjustment of position \u2014 are fundamental nursing care that significantly reduces pressure pain.<\/p>\n  <\/div>\n  <div class=\"outil-card\">\n    <h4>&#x1F4AC; Presence and voice<\/h4>\n    <p>A calm and familiar voice, gentle words, a caring human presence \u2014 have a documented analgesic effect. Not leaving a painful resident alone in their room is a full prescription of care.<\/p>\n  <\/div>\n<div class=\"outil-card\">\n    <h4>&#x1F4A7; Oral care<\/h4>\n    <p>Dry mouth is a major source of discomfort at the end of life. Regular oral care with moist swabs, glycerin, or cool water applied gently relieves this often underestimated suffering.<\/p>\n  <\/div>\n<\/div>\n\n<h2 id=\"role-soignant\">8. The caregiver's monitoring role<\/h2>\n\n<p>The caregiver who spends the most time with the resident \u2014 often the nursing assistant \u2014 is the first observer of pain. Their monitoring and reporting role is irreplaceable. A caregiver trained to recognize behavioral signs of pain, who systematically notes them in reports and alerts the nurse when something changes \u2014 this caregiver saves their resident from days or weeks of unnecessary suffering.<\/p>\n\n<p>This vigilance must be organized, not left to individual initiative. Clear protocols \u2014 when to assess, with what tool, how to report, when to alert \u2014 are quality care tools that structure this collective vigilance.<\/p>\n\n<h2 id=\"famille-douleur\">9. What families can do<\/h2>\n\n<p>Families can play a valuable role in monitoring pain \u2014 if they are given the means. Their knowledge of the resident \u2014 their usual expressions of pain, their behaviors when they are suffering, their preferred pain-relieving positions \u2014 is valuable clinical information that caregivers do not always have.<\/p>\n\n<p>Encouraging families to report their observations to the team, showing them the behavioral signs to monitor, explaining how to communicate their concerns \u2014 this actively integrates them into the care. And clearly telling them that their reports will be taken seriously \u2014 not minimized or dismissed with a \u201cit's normal at this stage\u201d which would be an unacceptable response.<\/p>\n\n<h2 id=\"droit\">10. The right to relief: asserting it<\/h2>\n\n<p>If a family believes that their loved one is suffering and that pain is not being adequately managed, they have the right \u2014 and perhaps the duty \u2014 to say so, to repeat it, to request a reassessment. They can ask to meet with the coordinating physician, request the intervention of the mobile palliative care team, or in extreme cases, appeal to the rights defender or an external physician.<\/p>\n\n<p>Untreated suffering at the end of life is not a fatality. It is an avoidable failure that training, vigilance, and therapeutic courage can help prevent. Training teams in the assessment and treatment of pain at the end of life \u2014 this is one of the most concrete investments a Nursing home can make for the dignity of its residents.<\/p>\n\n<a href=\"https:\/\/www.dynseo.com\/courses\/fin-de-vie-accompagnement-posture-soignante-et-soutien-des-familles\/\" class=\"internal-link\">\n  <div class=\"internal-link-icon\">&#x1F393;<\/div>\n  <div class=\"internal-link-content\">\n    <div class=\"internal-link-label\">Certified training<\/div>\n    <div class=\"internal-link-title\">End of life: support, caregiving posture, and family support<\/div>\n    <div class=\"internal-link-desc\">DYNSEO Qualiopi training \u2014 assessment and treatment of pain, comfort care, palliative sedation. For the entire Nursing home team.<\/div>\n  <\/div>\n  <div class=\"internal-link-arrow\">&#x2192;<\/div>\n<\/a>\n\n<div class=\"cta-box\">\n  <h3>&#x1F393; Train your team in pain management at the end of life<\/h3>\n  <p>The DYNSEO training \u201cEnd of life: support, caregiving posture, and family support\u201d covers pain assessment, the DOLOPLUS and ALGOPLUS tools, treatments, and non-drug approaches. Qualiopi certified.<\/p>\n  <div class=\"cta-buttons\">\n    <a href=\"https:\/\/www.dynseo.com\/courses\/fin-de-vie-accompagnement-posture-soignante-et-soutien-des-familles\/\" class=\"btn-cta-white\">&#x1F4CB; View the program<\/a>\n    <a href=\"https:\/\/www.dynseo.com\/formations\/\" class=\"btn-cta-outline\">All training &#x2192;<\/a>\n  <\/div>\n<\/div>\n<div class=\"article-tags\">\n  <a href=\"#\" class=\"article-tag\">end-of-life pain Nursing home<\/a>\n  <a href=\"#\" class=\"article-tag\">DOLOPLUS ALGOPLUS<\/a>\n  <a href=\"#\" class=\"article-tag\">morphine palliative care<\/a>\n  <a href=\"#\" class=\"article-tag\">deep sedation Claeys-Leonetti<\/a>\n  <a href=\"#\" class=\"article-tag\">pain relief elderly people<\/a>\n  <a href=\"#\" class=\"article-tag\">comfort care Nursing home<\/a>\n  <a href=\"#\" class=\"article-tag\">DYNSEO training<\/a>\n<\/div>\n<\/article>\n<\/div>\n\n<\/div>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]","_et_gb_content_width":"","footnotes":""},"categories":[2118],"tags":[],"class_list":["post-707925","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Relieving Pain at the End of Life: Rights, Options, and the Role of the Team - DYNSEO - Educational apps &amp; 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