As a person approaches the end of their life, they often experience various physical and emotional changes. Pain is one of the most common symptoms at the end of life. Identifying signs of pain is important so it can be properly managed and treated. This allows the person to be as comfortable as possible during their final days.

Physical Signs And Symptoms:

Facial Expressions:

The face is often very expressive when a person is in pain. Frowning, grimacing, tightly closed eyes, furrowed brow, clenched jaw, and moaning or crying can indicate pain or discomfort. Since those nearing end of life are often unable to communicate verbally, reading facial cues is important.

Body Movement:

Pain can cause an increase or decrease in physical movement. The person may fidget, thrash about, or constantly shift positions. Or they may become very stiff and immobile in an effort to minimize movement that causes pain. Clenched fists and tensed muscles often accompany the pain.

Changes In Vital Signs:

Elevated blood pressure, breathing rate, and pulse can signify pain or distress. However, near the end of life, vital signs often become irregular and inconsistent regardless of pain levels. Still, marked changes may correlate with apparent discomfort.

Loss Of Appetite:

Pain can lead to a decreased appetite and interest in eating or drinking. However, other factors like fatigue, nausea, and taste changes also affect appetite at the end of life. Checking for signs of pain when eating or drinking decreases can help determine the cause.

Difficulty Sleeping:

Discomfort may make it difficult to fall asleep or remain asleep. The person may vocalize pain at night or while attempting to reposition themselves in bed. Sudden awakening or altered sleep patterns may indicate pain or restlessness. You can buy pain relief products to ease the pain.

Agitation And Confusion:

Severe or chronic pain can lead to agitation like anxiety, irritability, and restlessness. Additionally, discomfort may contribute to or worsen confusion in the final stage of life. Moaning, aggressive behavior, calling out, and combativeness can be expressions of agitation related to untreated pain.

Emotional Symptoms:

Facial Expressions:

Grimaces, frowns, winces, tightened eyes, and furrowed brows may express emotional as well as physical distress. Crying can signal sadness, grief, fear, or psychological pain. Reading facial cues in context helps determine if the pain is emotional, physical, or both.

Social Withdrawal:

Emotional pain and sadness may cause the person to withdraw from social interaction. Loss of interest in activities, isolation, silence, and unresponsiveness can indicate psychological distress, depression, grief, or existential pain.


Frustration, irritability, and anger can manifest verbally or physically when emotional pain goes untreated near the end of life. The person may snap at loved ones, refuse care, or hit out from distress over their declining health and impending death.

Expressions About Death Or Loss:

Those nearing death may verbalize feeling depressed, anxious, or afraid related to dying. They may mourn losses like leaving loved ones behind. Talking about regrets over their life ending and feeling unprepared to die can reveal emotional pain.

Signs In Patients With Dementia:

People with dementia or other cognitive deficits have additional challenges expressing pain verbally near the end of life. Signs of discomfort may be more subtle or atypical.

Agitation like moaning, groaning, yelling, and murmuring may indicate pain they cannot articulate. Resistance during care, sudden aggression, and retreating inward can also stem from untreated pain.

Since dementia patients have difficulty communicating needs, discomfort is often expressed through behaviors. Crying, wandering, rocking, repetitive movements and facial grimacing should prompt an evaluation for pain.

Even severe pain may only cause mild physical reactions in those with dementia. Discomfort may manifest more emotionally in the form of distress, sadness, or agitation. Careful observation is key to ensuring their pain is recognized and managed.