Despite her vibrant looks and glamorous lifestyle, Hollywood icon Dame Elizabeth Taylor was no stranger to pain. In her 79 years she suffered from injuries, scoliosis and skin cancer, and endured more than 30 surgeries.
In the months leading up to her death Wednesday, those who knew her said she was wheelchair-bound with dark bruises on her arms.
"I'm happy that she's out of her pain, because she was in a lot of pain," fellow actress and one-time rival Debbie Reynolds told "Access Hollywood."
Taylor died six weeks after being hospitalized at Cedars-Sinai Medical Center in Los Angeles for congestive heart failure -- a condition in which the heart becomes unable to pump blood adequately to the rest of the body.
The details of Taylor's treatment are unknown, but she reportedly told Reynolds she was "really trying" to survive.
Congestive heart failure is generally not painful, although it can cause shortness of breath, according to Dr. Steve Nissen, chair of cardiovascular medicine at the Cleveland Clinic.
Treating Pain at the End of Life
Managing pain and shortness of breath, called dyspnea, at the end of life is a notoriously touchy subject. A possible side effect of the drugs used to relieve pain and anxiety -- opioids and benzodiazepines -- is sedation, which can hasten death.
"It's called the double effect -- the notion that at the end of life we use medications that we think are going to help with symptom management but also have the potential to accelerate the dying process," said Dr. James Fausto, director of the hospice and palliative medicine fellowship at Montefiore Medical Center, and assistant professor at Albert Einstein College of Medicine in New York City.
Pain and Dying: The Double Effect
The double effect has been the subject of many studies aimed at clarifying the risks of treating pain at the end of life. Some researchers argue that, in high enough doses, drugs like morphine and benzodiazepines can make it even harder to breathe. But others say managing pain appropriately can not only make life more comfortable, it can extend it.
"The theory is that pain, shortness of breath and anxiety can cause one to tire more quickly," Fausto said, citing studies that found patients who were treated for pain outlived those who weren't.
"In general, we feel that the benefits of treating symptoms outweigh the potential risk of accelerating the dying process," Fausto said.
But patients also worry about how pain management will affect their ability to be close to loved ones in their final days.
"There's a balance between controlling pain and enabling the interaction with loved ones that, most of the time, we can get to," Fausto said. "We tell patients that we want to get their pain under control while maintaining their ability to engage and say goodbye."
Another concern Fausto said he has to address with patients and families is the potential for painkiller addiction -- a condition that Taylor struggled with for years.
In 1990, prosecutors found that three doctors overprescribed pain medication to ease Taylor's back pain. An ongoing investigation into the death of her good friend Michael Jackson has yielded some similarities.
Taylor died surrounded by her children: Michael Howard Wilding, Christopher Wilding, Liza Todd and Maria Burton.
"My mother was an extraordinary woman who lived life to the fullest, with great passion, humor, and love," Michael Howard Wilding said in a statement. "We know, quite simply, that the world is a better place for Mom having lived in it. Her legacy will never fade, her spirit will always be with us, and her love will live forever in our hearts."