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Starts at $9.98 per contact hour
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4 hours $8.98
8 hours $7.98
12 hours $6.98
20 hours $5.98
30 hours $4.98

End-of-Life Issues: Pain Assessment and Management

3.5 Contact Hours
Target Audience: Nurses, healthcare professionals, and interested individuals
Purpose/Goal: The outcome of this course is for the learner to describe pain assessment and management for patients of all ages during their end-of-life care, including how to address cultural considerations and pharmacologic and nonpharmacologic management techniques of pain at the end of life.
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Pain assessment and management are especially important for high-quality end-of-life care. To provide quality care to individuals at this stage of their lives, health care practitioners must be particularly skilled at assessing pain, understanding misconceptions of pain management, addressing cultural issues in pain management, and providing effective pain therapies.

Upon completion of the course, you will be able to do the following:

  • Define pain.
  • Describe how pain affects the individual at end-of-life.
  • State common misconceptions and facts about pain.
  • Explain the pathophysiology of pain.
  • Identify the various types of pain.
  • Describe pain behaviors.
  • Explain the influence of culture on expressions of pain and on pain management.
  • Identify the key elements of pain assessment.
  • Describe barriers to effective pain management.
  • Describe key terms and the key elements of pharmacologic pain management
  • Describe key elements of nonpharmacologic pain management.
  • Describe the special considerations involved in treating a patient with a current or past history of substance abuse.
  • Describe the special considerations involved in managing escalating, severe pain.
  • Identify special issues related to end-of-life care and the pediatric patient.

Pain interferes with virtually every aspect of life—sleep, work, socializing with family and friends, hobbies, and activities of daily living. Pain is associated with injuries and disease. Sometimes pain is the cause of the disease (such as in headaches or neuropathic pain) and sometimes it occurs as a result of a specific condition (such as postoperative pain). Millions of people suffer from pain. It exacts a tremendous cost on our country in terms of health care costs, rehabilitation and lost worker productivity, as well as emotional and financial burdens for patients, families, and society. Consider these sobering statistics:

  • Pain affects more Americans than diabetes, heart disease, and cancer combined. Over 76.2 million people suffer from pain, compared to 26 million (for diabetes), 23 million (for heart disease), and 11 million (for cancer). Most of the pain sufferers are women (American Academy of Pain Medicine [AAPM], 2010; National Institutes of Health [NIH], 2011).
  • The annual cost of chronic pain in the United States, including health care expenses, lost income, and lost productivity, is estimated to be between $560 billion and $630 billion (AAPM, 2010).
  • An estimated 30% of patients with newly diagnosed cancer, 30% to 50% of patients undergoing treatment for cancer, and 70% to 90% of those with advanced malignant disease experience pain (Hart, 2010; Leleszi & Lewandowski, 2005).
  • More than half of all hospitalized patients experience pain in the last days of their lives. Yet, while there are therapies present to alleviate pain, for those dying of cancer, for example, 50% to 75% of patients die in moderate to severe pain (AAPM, 2010).
  • An estimated 20% of Americans report that pain or physical discomfort disrupts their sleep a few nights a week or more (AAPM, 2010).
  • The most common types of pain are low back pain, severe headaches or migraine pain, neck pain, and facial pain (AAPM, 2010).
  • Back pain is the leading cause of disability in Americans under 45 years of age (AAPM, 2010; NIH, 2011).
  • More than half of individuals experiencing pain feel they have little or no control over their pain (AAPM, 2010).
  • Pain management requires special attention with infants and children at the end of life, because they are not always able to describe the type, degree, or location of the pain they are experiencing (NIH, 2011).
  • Almost two-thirds of individuals report that pain impacts their overall enjoyment of life and more than 75% report feeling depressed, 70% say they have trouble concentrating, and 74% say their energy level is impacted (AAPM, 2010).
  • Most pain sufferers have been to their family physician for assistance and almost half have been to a specialist (such as an orthopedist) (AAPM, 2010).
  • The most common reason cited for seeking complementary and alternative medicine (CAM) and integrative therapies was pain (Cloud, 2011).
    • More than 8% of Americans have received a massage in the past year, usually for back or neck pain.
    • Approximately 11% of Americans have used meditation or deep-breathing exercises for physical and emotional pain.
    • Approximately 1.4% of Americans have experienced acupuncture.

Complete the course post exam (CE Test) with a score of 80% or greater. Complete all fields of the course evaluation form. Certificate of Completion is provided once the course post exam is passed per criteria above.

  • American Board of Managed Care Nursing
  • ANCC - American Nurses Credentialing Center
  • AOTA - American Occupational Therapy Association
  • ASWB - Association of Social Work Boards
  • California Board of Behavioral Sciences
  • California Board of Registered Nursing
  • California Department of Health, Aid, and Technician Certification Section
  • District of Columbia Board of Nursing
  • Florida Board of Nursing
  • Florida Board of Nursing - Certified Nursing Assistants
  • Florida Board of Respiratory Care
  • Florida Council of Dietetics and Nutrition
  • Florida Council of Licensed Midwifery
  • NAADAC - The National Association of Alcohol and Drug Abuse Counselors
  • NCBTMB -National Certification Board for Therapeutic Massage & Bodywork
  • Florida Board of Massage Therapists


Practice Level:


Content Focus:

Occupational Therapy Process

Course Expires:

May 30, 2019

  • Cyndie Koopsen, RN, BSN, MBA, HNB-BC, RN-BC, HWNC-BC
  • Caroline Young, MPH
Jurisdictional Requirements:

Continuing education (CE) licensing requirements vary by jurisdiction, are not well defined, and may change. These CE requirements may vary in terms of the number of hours required to the types of courses that must be taken. ALLEGRA Learning Solutions, LLC recommends you contact your licensing board or accrediting organization for the latest continuing education requirements of your state or territory. Compliance with CE requirements is the responsibility of the individual health care provider. Health care providers must understand the CE requirements in their jurisdictions, and be sure they are up-to-date on any rule changes that affect their license. For further information, please see our Accreditation Information.

Accommodations for Disabilities:

Every effort will be made to accommodate your special needs. To request accommodations, please contact us.

Conflicts of Interest and Relevant Financial Relationships:

The authors/planning committee members have no conflicts of interests or relevant financial relationships to declare relevant to this activity.

Commercial Support:

No commercial support has been received for this activity.

Non-endorsement of products:

Accreditation refers to recognition of continuing nursing education only and does not imply ALLEGRA Learning Solutions, LLC approval or endorsement of any commercial product.

Off-label Use of Products:

None of the authors intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.