When Chronic Pain Becomes a Palliative Issue: A Case Series and Clinical Considerations

IntroductionThe boundary between chronic pain management and palliative care remains ill-defined. Contemporary chronic pain management incorporates pharmacologic, interventional, rehabilitative, and behavioral approaches to improve pain, function, and quality of life. Palliative care shares many of these goals while emphasizing the recognition and management of multidimensional suffering across physical, psychological, social, and existential domains. For some patients, chronic pain becomes intertwined with functional decline, cognitive or communication impairment, multimorbidity, and psychological distress, creating complex supportive care needs that may benefit from palliative care involvement.Case DescriptionThree cases illustrate clinical situations in which palliative care complemented conventional chronic pain management: (1) refractory pain from calciphylaxis associated with severe functional impairment, in which treatment incorporated patient-defined functional goals; (2) suspected pain contributing to agitation in a patient with frontotemporal dementia and expressive aphasia, requiring caregiver-informed symptom assessment and comfort-oriented care planning; and (3) chronic musculoskeletal pain complicated by multimorbidity, anxiety, and concerns about opioid addiction, in which shared decision-making facilitated reconsideration of analgesic therapy. Across cases, palliative involvement was associated with improvements in comfort, function, or distress.ConclusionChronic pain may warrant palliative care involvement when pain occurs within broader multidimensional suffering that is inadequately addressed despite conventional pain management. Exploratory clinical features identified across these cases may help clinicians recognize circumstances in which palliative care involvement could be considered, although further research is needed to evaluate their clinical utility.