Signs and symptoms


Everyone experiences pain differently. Proper pain control allows for a better quality of life.

The goal of palliative care is to ease pain and provide as much comfort as possible.

Pain is not just physical; it can be emotional, social or spiritual.

Signs of physical pain

The patient:

  • says it hurts
  • is crying
  • is agitated or irritable
  • is making a face or wincing
  • is curled up and tense

Signs of pain that is not physical

The patient:

  • talks about mental anguish
  • has a feeling of despair and emptiness inside
  • says they want to be done with it
  • has financial concerns
  • is afraid of leaving their family behind them
  • feels like they are a burden
  • feels the need to reconcile with a loved one


Methods other than medication for managing pain

  • Distraction
  • Breathing exercises and meditation
  • Music therapy
  • Applying heat or cold
  • Presence of someone to listen

Examples of medications to manage pain

  • Analgesics (acetaminophen)
  • Non-steroidal anti-inflammatory drugs – NSAIDs (Aspirin, ibuprofen)
  • Opioids (morphine, hydromorphone, codeine)
  • Anticonvulsants (gabapentin)
  • Antidepressants (amitriptyline)
  • Steroids (prednisone, dexamethasone)

To properly manage pain, medications must be taken on a regular basis with additional doses as needed for unusual pain.

Constant pain require constant doses. When medications are administered properly, they are safe and effective.

The care team also addresses the side effects of pain medications, such as:

  • nausea and vomiting
  • constipation
  • dizziness
  • drowsiness
  • confusion

These side effects do not always persist. Some of them disappear or decrease after a few days.


It is normal for the illness to cause a decrease in appetite. The body does not digest food like it did before and the patient often loses weight.

Loss of appetite may be caused by:

  • medications
  • pain
  • intestinal blocage or constipation
  • sores in the mouth

Tips to make eating easier

  • Let the patient eat at the time of day that they feel best.
  • Let the patient have several small meals a day instead of three large ones.
  • Let the family give the patient whatever they prefer to eat.
  • Let the patient try fluids and nutritional supplements (sometimes these are tolerated better than solids).

Preparing a good meal for the patient is a way of showing them love. The natural reflex is to encourage the patient to eat and drink to build their strength. However, it is important to remember the following:

  • The goal is to respect the patient’s limits and feed them without causing them discomfort.
  • Any food and any drink that the patient asks for is acceptable.
  • The patient’s preferences are more important that the nutritional value of the food.
  • It may be normal for a patient to eat very little or not at all.


Toilet habits may change over the course of the illness. Changes in the voiding of stool and urine may be caused by:

  • medications
  • the fact that the patient is eating less
  • a reduction in physical activity
  • the illness

Symptoms to report

  • No stool for three days
  • Several bouts of diarrhea in one day
  • Blood in urine or stool
  • Cramps, nausea or vomiting
  • Bloating or swelling of the abdomen

Tips for voiding

  • Use incontinence pads or briefs as needed.
  • Maintain good hygiene of intimate parts.
  • Keep the skin and bed linens clean and dry.
  • Apply a protective cream to avoid rashes.
  • Drink plenty of water and increase fibre intake.


The patient may experience shortness of breath, coughing fits or difficulty breathing.

These discomforts may be caused by:

  • the illness
  • a general weakness
  • a blocage
  • anxiety

Symptoms of a patient who has difficulty breathing

  • Headaches
  • Heaviness in the chest
  • Thick secretions and cough
  • Noisy or rapid breathing at rest

Tips to make breathing easier

  • Choose a comfortable position.
  • Wear loose-fitting clothing.
  • Plan rest periods.
  • Avoid smoking.
  • Stay away from allergens.

Nausea and vomiting

Nausea is the sensation of feeling sick to your stomach, wanting to vomit or discomfort at the back of the throat. It can adversely affect quality of life.

Nausea may be caused by:

  • the side effects of medications
  • constipation
  • irritation of the stomach or intestines
  • infection

Tips for managing nausea and vomitting

  • Eat small portions.
  • Avoid fatty, spicy or acidic foods.
  • Avoid lying down within two hours after a meal.
  • Change positions slowly.
  • Perform oral care regularly.
  • Keep a bowl handy.


Confusion often occurs when the patient has difficulty speaking, thinking, reasoning and understanding what is happening around them. It may be temporary or permanent, depending on the cause.

Confusion may be caused by:

  • the illness
  • infection
  • lack of oxygen
  • medications
  • pain

Signs of confusion

  • Memory or attention issues
  • Lack of concentration, difficulty following a conversation
  • Behaviour problems (aggressiveness, paranoia)
  • Hallucinations

Tips for managing confusion

  • Stay calm and speak slowly.
  • Remind the patient where they are and of the date and time.
  • Use short and simple sentences.
  • To avoid upsetting the patient, do not contradict them.
  • Reduce stimulants (reduce the number of visitors, noise).
  • Bring in familiar items from home.


Illness often leads to sleep problems. These may be caused by:

  • fear
  • sadness
  • pain
  • coughing
  • nausea

Tips for improving sleep

The patient can:

  • reduce noise and light at bedtime
  • lay down when they feel tired
  • avoid caffeine and nicotine before bed
  • talk about their concerns
  • use relaxation techniques