On 10 October, communities around the world will mark World Hospice and Palliative Care Day 2026, with the theme Pain Management: An Essential Part of Palliative Care. The theme was chosen by the World Hospice and Palliative Care Day 2026 organisers to re-emphasise the holistic treatment of pain in palliative care, recognising that suffering is not only physical but can also be psychological, social and spiritual.
There are several key principles that guide pain management in palliative care:
- Everyone’s experience of pain is different.
- Pain is common in people living with a terminal illness, but not all patients will experience pain.
- Pain is subjective. Pain is what the patient says it is.
- Physical pain can be made worse by psychological worries and distress.
These principles remind us that effective pain management begins with listening to the individual and understanding their unique experience.
Pain that cannot always be seen
For someone living with a life-limiting illness, pain may stem from much more than physical symptoms.
Psychological pain may include fear of the future, anxiety about treatment, depression, uncertainty, or concern about loved ones.
Social pain can arise from isolation, loss of social roles, financial pressures, relationship difficulties, or reduced ability to participate in activities that once brought joy.
Spiritual pain may involve questions about meaning, identity, hope, faith, forgiveness, or what lies ahead.
These forms of distress are deeply interconnected. A person who feels lonely, frightened or overwhelmed may experience their physical symptoms more intensely. Likewise, addressing emotional and social concerns can sometimes help reduce a person’s overall suffering.
What does this mean for clinicians?
The concept of total pain challenges clinicians to look beyond physical symptoms and recognise the complex interplay between physical, psychological, social and spiritual suffering. In this 2025 paper, Top Ten Tips Palliative Care Clinicians Should Know About Total Pain, researchers emphasise that effective pain management requires a holistic, person-centred and multidisciplinary approach.
Key takeaways for clinicians include:
- Provide a safe space and listen actively to better understand the patient’s pain narrative; use open-ended phrases (e.g., “Tell Me More”) to gain a comprehensive understanding and validate their emotional expression of pain
- The causes, covariates, and presentations of total pain are complex and subjective; expect the unexpected and individualize interventions to meet patients where they are in their pain experience
- When treating physical aspects of total pain, employ a polymodal analgesic pharmacological approach, including anesthesia-based interventions focused on various anatomical elements of patients’ physical pain where applicable
- Incorporate nonpharmacological integrative approaches (e.g., acupuncture, massage therapy) for their dual benefits on physical and psychological pain
- Plan for early intervention from psychiatric/psychological care colleagues for patients with preexisting complex behavioral and psychological comorbidities and those with personality disorders
- Include a detailed initial spiritual assessment to understand and address the various causes of spiritual pain
- Incorporate regular evaluation and documentation of spiritual needs, and include interprofessional spiritual care throughout all illness phases and transitions
- Provide dignity-oriented therapies that are adapted to the person, population, and culture to reduce social and psychological aspects of total pain
- Cocreate and encourage a mutually acceptable SDM process based on patients’ value systems and treatment preferences
- Ensure you are actively integrating the expertise of multidisciplinary colleagues including social workers, chaplains, psychologists, nutritionists, and integrative specialists in screening for and treating all aspects of patients’ total pain and in supporting their caregivers
As the theme for World Hospice and Palliative Care Day 2026 reminds us, pain management is an essential part of palliative care. The evidence suggests that achieving this requires more than symptom control alone. It calls for a comprehensive approach that acknowledges the whole person and seeks to relieve suffering wherever it exists, whether physical, psychological, social or spiritual.
Further reading: Top Ten Tips Palliative Care Clinicians Should Know About Total Pain (2025) – https://pmc.ncbi.nlm.nih.gov/articles/PMC13102129/
Learn more about World Hospice and Palliative Care Day 2026: https://thewhpca.org/world-hospice-and-palliative-care-day/