Efficacy of Hylenex in the Treatment of Pain Among Hospice Patients

Inclusion Criteria: 1. Non-pregnant, non-lactating adults 18+ years enrolled in inpatient facilities at LifePath or Good Shepherd Hospice 2. Ability to provide informed consent; Patient has decision-making capacity (SPMSQ score 6+) 3. Ability to provide numerical report on pain level on pain scale 4. English-speaking 5. Pain not satisfactorily controlled with current meds -oral, topical, or rectal; Pain level greater than 3 at admission on a 0-10 scale 6. Able to self-administer bolus dose or ask someone to hit bolus button 7. Estimated life expectancy of 3 days or more 8. Patients appropriate for continuous SC infusion with either morphine or hydromorphone. Exclusion Criteria: 1. History of allergy or hypersensitivity to Hylenex or any components of product 2. Patients on infusion therapy for pain management up to 14 days prior to entering inpatient facilities. 3. Patients who are actively dying identified by any of the following physical signs and symptoms: 1. non-communicative or unresponsiveness; b) confusion/disorientation about time, place, and people; c) significant chest congestion with gurgling sounds; d) restless and repetitive motions; e) little or no food or fluid intake; f) minimal urine output and g) different breathing pattern, i.e., shallow rapid breaths with period of no breathing.