Medicine is meant to heal, alleviate suffering, and restore function. But what happens when pain becomes persistent, when mobility declines, when relief, rather than cure, becomes the priority?
In the field of physical medicine and rehabilitation (PM&R) and pain management, I have seen patients left in unnecessary distress, families grappling with false hope, and interventions that prolong suffering instead of easing it. These truths are often ignored, buried beneath the belief that aggressive treatment equates to better care.
But the greatest failure in medicine is not stopping death. It is failing to acknowledge when treatment is no longer serving the patient.
Dementia Patients Feel Pain Yet Are Left To Suffer
One of the most damaging misconceptions in pain management is that patients with advanced dementia somehow (for whatever reason) do not feel pain, or that treating their pain will further impair their cognition. Blatantly false. This assumption leads to inhumane undertreatment, where fractures, surgical wounds, and chronic conditions remain neglected simply because the patient cannot verbally express suffering.
Consider the case of a woman with advanced dementia and a tib-fib fracture, left without pain medication because the physician feared it would “make her more demented.” The reality? Her body was already tense with discomfort, her movements restless, her silence heavy with unspoken agony. She needed pain relief just as the cognitively intact person would need it.
Aggressive Treatment Versus Pain Management: The Struggle for Balance
PM&R is about function, recovery, and optimizing quality of life. Yet, for many patients in advanced stages of illness, aggressive treatment overshadows the value of comfort and acceptance.
Take the case of a man with Stage 4 colon cancer, exhausted from chemotherapy, his body frail and failing. His family clung to the belief that another cycle of treatment could still turn the tide, though no path to remission remained.
What was truly needed? Pain management, comfort-based care, and open conversations about how to preserve dignity rather than prolong suffering.
The Ethical Imperative: Medicine’s Duty To Alleviate Suffering
The Hippocratic Oath (modern version), taken by physicians worldwide, includes the promise:
Yet, medicine often falls into these traps — either treating too aggressively, prolonging suffering, or hesitating to provide adequate relief for fear of appearing passive.
Ethically, physicians hold the responsibility not only to fight disease but to reduce suffering. The principle of beneficence, doing what is best for the patient, must include:
1) Pain relief, when pain becomes unavoidable.
2) Honest conversations about prognosis, rather than false reassurance.
3) Recognition that comfort-focused care is not abandonment but an act of respect and compassion.
Let us not fear death. It is natural and inevitable in the path of disease progression (not amenable to further care/treatment). But rather, let us fear the suffering caused when we refuse to acknowledge it.
Modern medicine must evolve — not toward more treatments, but toward deeper understanding.
We must recognize when comfort matters more than intervention, when dignity must take precedence over false hope. Physicians are not merely healers; no, they are guides through life’s most challenging transitions. And guiding a patient toward peace, rather than pushing futile treatment, is not failure — it is compassion.
Let this be the conversation we embrace, not with resignation but with love and respect for those in their most vulnerable moments.
How can we better balance pain relief and realistic outcomes in advanced illness? Share in the comments.
Dr. Ivan Edwards is a physician, ordained minister, military officer, and writer dedicated to service and holistic well-being. A board-certified physiatrist with over two decades of experience, he specializes in physical medicine and rehabilitation, with a focus in neurorehabilitation and comprehensive pain management, optimizing patient care through a functional and patient-centered approach.
Patient details have been masked to protect identity.
Illustration by April Brust
