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The process of dying is one of medicine’s greatest mysteries. We are still not able to identify precisely which are the mechanisms that initiate the process of dying and after which moment it really becomes irreversible. However, despite all of the advances and the commitment of science to life, few health professionals, especially physicians, acquire expertise in the technical and emotional knowledge necessary for the care of the dying person. Within the process of dying, there is still plenty of space for life. Palliative care has become a symbol of imminent death, since it is only in the last moments that the reality of “having nothing else to do” is considered. This is why the stigma of palliative care is so deep and painful.

Looking back, in the face of finitude, is what brings us the greatest unrest. When faced with the consciousness of death, the first thing we look at is the life we have had up until that moment. The time comes to rethink choices made a long time ago—that moment when you think, “Have I taken the right path? Had I taken the longest path, would it have been nicer and taken longer to arrive?” Making oneself happier is related to helping someone who is dying and thoroughly looking at that person and recognizing yourself as their equal, because we too are dying. And the most amazing way of helping is being present in that space.

In the palliative care approach, the most important will is the patient’s, and their voice is the one that governs and determines the direction of care. Therefore, a well-conducted assessment is the first and most fundamental step toward the success of this work. An insufficient or imprecise evaluation can result in a succession of errors and mistakes in diagnostic or therapeutic procedures. We have our history and our biography, and in this biography we have our faces, composed of broad dimensions that characterize us: the biological dimension, the emotional dimension, the family dimension, the social dimension, and the spiritual dimension.

With the advances of the Industrial Revolution and its educational, scientific, and technological developments, it became clear that economic development has two effects on the population: (1) it reduces mortality rates in general, reduces infant mortality in particular, and makes it possible to improve the population’s living conditions; and (2) after a certain period of time when mortality starts to fall, fertility rates also start to fall, causing a decrease in the size of families. An unequivocal gain is that the average life expectancy of the world population has doubled. The biological context of aging and appropriate management of multiple simultaneous diseases adds to the whole challenge of managing relational models. The dignity of life must be a right for all inhabitants of this world, and this experience of the dignity of human life can offer its best performance in good palliative care practice.

In the roots of medical practice there was a certain harmony between science and the mystical priesthood, which surrounded the physician’s powers to evaluate and cure illness. Nevertheless, the art of predicting the future has not yet become sufficiently scientific to the point of specializing the physician in the exercise of prognosis. This evaluation seeks constant support from use of scales, signs, and symptoms that may identify the death process at the early stages, but it still involves rather complex physiological and social resolutions.

Anticipatory grief is the experience of each of the stages of mourning experienced by the patient and their loved ones during the illness process, where the awareness of finitude happens. Being aware of your death means that the entire grieving process is experienced in advance as a perception of the reality of the death that will come. Mourning is the social manifestation of a socially assumed feeling of grief in the face of an experience of loss. Our life is inevitably forever affected by the end of a relationship, situation, project, or dream. The health effects of the mourning period—and even the risk of mortality in the most vulnerable people, such as the elderly—are well known and documented. Although the evidence is clear, little or nothing is done to minimize the risk of life-threatening problems in people in the grieving process. It is very important to remember that grieving is an intense and necessary process, but that caring for the health of the grieving person, in all of its dimensions, is essential for the pain to go away and leave only the memory of what was lived, with even greater value.

Humans beings are complex beings, gifted with multiple impressions regarding the world and themselves, learned and incorporated into their way of living and thinking throughout their lives. At birth, we are essentially a biological being, but as we grow older our biographical dimension is enriched. And our suffering dimension goes way beyond suffering from physical illness. The perceptions of discomfort and disease burden among patients in palliative care are highly individualized.

To be considered a caregiver, one must be a health professional who also cares for patients (whether they are hospitalized or not) or a family member, friend, or companion who cares for someone who is in need of any type of care. At this point, it does not matter what type of caregiver you are and whether you are professional or not; what matters is that you know that in order to give care, you need to know who you are very well and why you have chosen to care for someone. Caring is the act of taking care of another person and of yourself. The more whole and present I am in myself, the more ready I am to care for someone.

The latest statistics regarding human mortality on our planet show that of the 56.9 million deaths that occurred worldwide in 2016, more than half (54%) were related to ten diseases, which, in their natural course, cause suffering in all dimensions—physical, emotional, family, social, and spiritual—despite all available treatments. These diseases have remained the principal causes of global death for the last 15 years, and it is worth mentioning that they account for an announced statistic of death; that is, these people were diagnosed with diseases that threaten the continuity of life, and they would therefore have been candidates to receive palliative care. The suffering of the health professionals who took care of these people is not recognized, or legitimized, or even allowed in our culture of health care (or, rather, illness). The whole process of self-care should convey to the health professional that their life is as important and valuable as all of the lives they are dedicated to caring for. Therefore, it should receive the same attention to—and care for—its own human dimensions: physical, emotional, family, social, and spiritual. With this care, we can then dedicate ourselves in a more conscious way and become more capable of achieving the results that we long for in our work.

CONTEXTO: Dor é um dos sintomas físicos mais freqüentemente relatados por pacientes, causando importante redução na qualidade de vida do indivíduo. Pacientes com dor crônica são difíceis de tratar. OBJETIVO: Descrever estratégias atuais de abordagem de pacientes com dores crônicas, baseadas na literatura científica, enfatizando medidas relacionadas à espiritualidade e à religiosidade. MÉTODO: A presente revisão utilizou-se das atuais estratégias de manejo para pacientes com dor crônica combinadas a medidas medicamentosas e não-medicamentosas, estas geralmente incorporando medidas voltadas ao bem-estar físico, mental, social e espiritual com base em publicações indexadas pelo Medline. RESULTADOS: Muitos estudos demonstram associação positiva entre espiritualidade e religiosidade e melhora em variáveis e marcadores de doenças crônicas. CONCLUSÃO: Pelo fato de a religiosidade e a espiritualidade serem marcadamente relacionadas com a melhora clínica dos pacientes, é importante que o reconhecimento desses aspectos e a integração no manejo dos pacientes com dor crônica sejam conduzidos por profissionais da área de saúde.BACKGROUND: Pain is one of the most common physical complaints which negatively affects the patient’s quality of life. Patients with chronic pain are difficult and often frustrating to treat. OBJECTIVE: To describe the current strategies for approaching patients with chronic pain based on scientific literature, emphasizing measures related to spirituality and religiosity. METHOD: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based on indexed Medline data. RESULTS: Many studies have demonstrated a positive association between spirituality and religiosity and improvement of chronic diseases’ variables and markers. CONCLUSION: As religiosity and spirituality are notoriously related to the patient’s clinical improvement, it is highly important that the recognition of these aspects and their incorporation in the management of patients with chronic pain be conducted by health professionals.

CONTEXTO: Dor é um dos sintomas físicos mais freqüentemente relatados por pacientes, causando importante redução na qualidade de vida do indivíduo. Pacientes com dor crônica são difíceis de tratar. OBJETIVO: Descrever estratégias atuais de abordagem de pacientes com dores crônicas, baseadas na literatura científica, enfatizando medidas relacionadas à espiritualidade e à religiosidade. MÉTODO: A presente revisão utilizou-se das atuais estratégias de manejo para pacientes com dor crônica combinadas a medidas medicamentosas e não-medicamentosas, estas geralmente incorporando medidas voltadas ao bem-estar físico, mental, social e espiritual com base em publicações indexadas pelo Medline. RESULTADOS: Muitos estudos demonstram associação positiva entre espiritualidade e religiosidade e melhora em variáveis e marcadores de doenças crônicas. CONCLUSÃO: Pelo fato de a religiosidade e a espiritualidade serem marcadamente relacionadas com a melhora clínica dos pacientes, é importante que o reconhecimento desses aspectos e a integração no manejo dos pacientes com dor crônica sejam conduzidos por profissionais da área de saúde. BACKGROUND: Pain is one of the most common physical complaints which negatively affects the patient’s quality of life. Patients with chronic pain are difficult and often frustrating to treat. OBJECTIVE: To describe the current strategies for approaching patients with chronic pain based on scientific literature, emphasizing measures related to spirituality and religiosity. METHOD: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based on indexed Medline data. RESULTS: Many studies have demonstrated a positive association between spirituality and religiosity and improvement of chronic diseases’ variables and markers. CONCLUSION: As religiosity and spirituality are notoriously related to the patient’s clinical improvement, it is highly important that the recognition of these aspects and their incorporation in the management of patients with chronic pain be conducted by health professionals.