Death is an inevitable part of life that everyone must face eventually. Many people accept this reality, with studies indicating that over half of those surveyed are not afraid of death. However, 42% of people do have some fear of dying (per Statista). Moreover, one in four Americans report having no fear of death at all.
While fear of death may not be overwhelming, it can still affect individuals to varying extents. According to a 2017 study in Frontiers in Medicine, death anxiety, or thanatophobia, often focuses more on the dying process than death itself. The study found that nearly 80% of people were particularly anxious about dying painfully. However, a 2020 study in BMC Palliative Care revealed that less than 20% of patients experienced severe pain in their final month of life. Nonetheless, certain diseases can make dying a notably painful experience.
Pancreatic cancer
Tumors from pancreatic cancer can impact nerves near the pancreas. Additionally, tumors can block the duodenum, part of the small intestine, leading to pain and discomfort. Fluid accumulation in the stomach, known as ascites, can also occur and cause pain.
Less commonly, pancreatic cancer can spread to bones, causing painful issues such as bone pain or fractures during normal activities. It can also compress the spinal cord, resulting in back pain and numbness in the lower extremities. In severe cases, this can lead to bladder and bowel incontinence. The cancer can damage bone cells, causing elevated calcium levels in the blood, which can result in symptoms like aches, excessive thirst, and kidney failure.
Osteosarcoma
Bone cancer can cause pain from the outset as tumor growth presses on nerves and blood vessels within the bone’s layers. This not only causes pain but can also restrict movement. (Here are the warning signs of bone cancer you shouldn’t ignore.) The American Cancer Society notes that pain around the tumor can worsen at night or when walking. Tumors can also weaken bones, leading to sudden and painful fractures.
A 2021 study in the Journal of Advanced Research highlights that bone erosion from certain cancers, like Ewing’s sarcoma, can be severe enough to appear as though the bone is being eaten away. Tumor growth can also activate immune cells in the spinal cord, releasing inflammatory substances that increase sensitivity to pain—a process known as central sensitization, which can make even normal movements painful over time.
End-stage ALS
Amyotrophic lateral sclerosis, or ALS, is a progressive disease that weakens nerve cells in the brain and spinal cord, leading to muscle weakness over time. (Read about how ALS is treated.) As the disease advances, basic functions like walking, speaking, and breathing become increasingly difficult. According to the University of Virginia, ALS patients can experience “locked-in” syndrome, where they remain fully alert but unable to move.
This stage of ALS poses numerous challenges for both patients and caregivers. A 2002 study in Neurology reported that over half of end-stage ALS patients experienced dyspnea, or breathing difficulties, and frequent, severe pain. Additionally, 48% of caregivers noted discomfort of various kinds among patients at this stage.
Gallbladder cancer
Gallbladder cancer can cause pain in various ways. Typically, it manifests as aching in the upper right abdomen. If gallstones block the bile ducts, the pain may be sharp. As the cancer progresses, growing cells can stretch organs or fully block bile ducts, leading to severe pain.
Pain from gallbladder cancer can also result from cancer cells affecting the celiac plexus, a nerve cluster near the liver. This can cause sharp, stabbing, cramping, or squeezing pain. If this occurs, a celiac plexus block procedure may be recommended to numb the nerves and manage pain. (This is the type of diet you should follow if you have gallstones.)
Necrotizing fasciitis
Necrotizing fasciitis, a flesh-eating bacterial infection, is a rare but serious condition that can be fatal if untreated. The Centers for Disease Control and Prevention states that the condition can lead to shock, sepsis, and organ failure. It may also necessitate limb amputation to prevent death. Even with treatment, one in five people with necrotizing fasciitis do not survive.
Symptoms include dehydration, diarrhea, nausea, and dizziness. As the disease progresses, patients may experience limb swelling, purple rashes, and skin peeling as tissue death occurs. A 2017 report in the British Medical Journal notes that necrotizing fasciitis can result in toxic shock syndrome, a condition with a 70% fatality rate marked by multiorgan failure.
Huntington’s disease
Huntington’s disease, though rare, is a genetic condition that causes brain nerve cell decay. It leads to involuntary muscle movements, such as jerking, as well as muscle rigidity. The disease also causes cognitive and mental health issues, like impulsivity, irritability, and suicidal thoughts.
Patients with Huntington’s disease often experience significant pain, which is frequently overlooked. According to Huntington’s Disease News, four out of five patients in nursing homes and half of those at home report being in pain. Symptoms include headaches, abdominal pain, and fractures from uncontrolled movements. Due to cognitive effects, many patients do not manage their pain, leading to constant suffering. Currently, there is no cure for Huntington’s disease.
Esophageal cancer
Esophageal cancer can initially present with pain. Patients may experience pain when swallowing, known as odynophagia, and difficulty swallowing, which worsens as the cancer grows. Additionally, symptoms like heartburn, chest pain, chronic cough, and hoarseness may occur.
As the disease advances, symptoms become more severe. Patients may suffer from bone and joint pain, esophageal bleeding, sore throat, and difficulty speaking. According to Dr. Belal Bin Asaf, end-stage esophageal cancer tumors may invade other organs, such as the lungs, liver, and bones, causing extreme pain. Caregivers should have pain management strategies in place for those with end-stage esophageal cancer.
Ebola
Ebola virus is a rare but severe disease with a 50% fatality rate, according to the World Health Organization. In past outbreaks, mortality reached 90%. Transmitted through blood, bodily fluids, or contaminated surfaces, the disease presents suddenly with fever, muscle pain, and headaches. The Centers for Disease Control and Prevention refer to these as the “dry” symptoms. As the disease progresses, it enters the “wet” stage, marked by watery diarrhea, vomiting, and severe abdominal pain.
In late stages, these “wet” symptoms worsen. They may include bloody vomit or coffee-ground-like vomit, bloody stools, and rashes with blood blotches under the skin. (Here’s what’s happening to your body when you vomit.) Patients may also experience brain inflammation, seizures, organ failure, and shock.
Rabies
Although rare in the U.S., rabies is almost always fatal once it reaches the central nervous system. It is typically transmitted via saliva from warm-blooded animals like skunks, foxes, raccoons, and bats. Dogs and cats can also carry rabies. In the U.S., bat bites are the most common cause, with bite marks often so small that they go unnoticed until symptoms appear. (Here’s what to do after a bat bite.)
Initially, rabies may resemble the flu, with symptoms like fever, sore throat, nausea, and vomiting. However, as it progresses, symptoms become severe and frightening, including aggression, confusion, paralysis, hallucinations, nightmares, and convulsions. The disease also causes intense throat spasms, making drinking impossible. In the end, even thinking about drinking can trigger spasms, creating the impression that the patient fears water.
