The Total Pain Model - 9 Key Points

  • The hospice model of care is based upon the concept of "total pain," which acknowledges that patients with serious and life-limiting illness suffer because of physical, emotional, social and spiritual sources of pain and suffering. 
  • Pain and suffering are related, but not necessarily the same. Pain, whether physical or emotional, has a physiologic basis. Suffering, on the other hand, arises when we apply meaning to or tell ourselves stories about the pain we are experiencing. 
  • Pain can often be alleviated or improved with medication, whereas suffering often is resistant to medication. Failing to recognize the difference can lead to over-medication and over-sedation of patients who have serious and life-limiting illness. 
  • Seriously ill patients and their families often resist the recommendation for a hospice referral due to concern about over-sedation and over-medication. Understanding the role of the hospice team in addressing total pain can enable to referring physician to alleviate these concerns. 
  • Suffering can be successfully evaluated and treated by using a spiritual pain model that addresses the following four aspects: forgiveness, meaning, relatedness, and hope. (See "Supplementary Online Resources" below to access a spiritual health evaluation clinical tool offered by the Sacred Art of Living Center.)  
  • Pain and suffering, particularly in the setting of terminal illness, often involves and affects the caregivers in addition to the patient. The hospice team can be a valuable resource in terms of time and expertise in helping the referring physician address and manage the complex impact of pain and suffering on family relationships.  
  • The hospice transdisciplinary team is comprised of compassionately skilled professionals from many disciplines who work as a cohesive and integrated unit. This allows the patient and family to receive focused care that addresses the complexity of terminal illness.  
  • The appropriate management of suffering, especially spiritual pain, requires time, and is best delivered by hospice involvement early in the course of a terminal illness.  
  • Appropriately timed referrals that allow sufficient time for hospice to do this important work are fundamental to maximizing quality of life and achieving peace for both the patient and caregiver.  
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About Dr. Kevin Dieter

Dr. Kevin Dieter, M.D., FAAHPM, is Medical Director at David Simpson Hospice House and supervises the agency’s Lakeshore East home care clinical teams. He is a nationally known speaker on the “total pain” model of care, a holistic approach to addressing pain and suffering.

Dr. Dieter earned his medical degree at Northeastern Ohio Universities College of Medicine (NEOMED) in Rootstown, Ohio, in 1985. He is Board Certified in Hospice and Palliative Medicine as well as Family Medicine and is a Fellow of the American Academy of Hospice and Palliative Medicine.

Additional Resources

Spiritual Health Assessment Form

The Total Pain Model - 9 Key Points