When the hiccups don't stop: Rethinking care for a hidden struggle in palliative care
An article written by Dr Adarsh Das and A/Prof Jayamangala Sampath Kondasinghe, Palliative Care Service, Sir Charles Gairdner Hospital
We’ve all been there. You eat too fast or drink a fizzy beverage, and suddenly - ‘hic’. It’s annoying, maybe a little funny, but usually, it’s over in a few minutes, laughed off with a glass of water, a ‘fright’ or a held breath. Now, imagine that sensation lasting for days. Weeks. Even months. For many people receiving palliative care, this isn't a hypothetical scenario; it is a daily reality. Chronic and intractable hiccups are more than just a nuisance. [1] They can become a relentless source of exhaustion, disrupting sleep, making it impossible to eat comfortably, and making conversation difficult. [2] Despite how distressing this is, it is a symptom that often flies under the radar. [2]
A new review published by our team is shining a light on this hidden burden. By looking into existing research, we have highlighted a crucial gap in how we treat this condition: we are focusing too much on the ‘cure’ and not enough on the person. [1]
What the research tells us
We looked at 88 studies involving over 150 patients as well as six other reviews that were performed on various cohorts on this phenomenon. They looked at the medical side of things, noting that drugs like gabapentin and baclofen appear to be the most effective options currently used by doctors, as well as dopamine antagonists and benzodiazepines. However, the most valuable insights came from looking beyond the medicine cabinet. The review uncovered a few critical themes:
- The emotional toll is heavy. Hiccups aren't just physical spasms; they cause profound psychosocial distress. Patients reported feeling embarrassed, frustrated, and worn down by their inability to control their own bodies.
- A stark discordance persists between reported efficacy and clinical reality, where treatments frequently fail to alleviate patient burden. While the quantitative synthesis indicates high efficacy for most drugs, qualitative data reveal a ‘therapeutic void’ defined by patient suffering and provider frustration. This gap inevitably forces clinicians into a reactive cycle of trial-and-error approaches rather than evidence-based protocols.
- Patients aren't necessarily demanding a 100% cure. From one study, patients wanted practical strategies that reduce their hiccups burden enough to let them sleep, eat, and function, rather than holding out for a total resolution that might never come.
Why this matters
We concluded that the current evidence for treating chronic hiccups is of ‘very low certainty’. In plain English? We don't have a foolproof way to stop them yet for patients in palliative care settings. Why? Because in many of these patients with life-limiting illnesses and malignancies, there are usually multi-factorial causes for their hiccups, and there is no one-stop solution for multiple factors. Because of this, we suggest a shift in thinking. Instead of trying to ‘fix’ the hiccups entirely, healthcare providers should aim for ‘palliative control’. This means shifting the goalposts from cure to comfort. It aligns perfectly with the heart of palliative care: prioritising what matters most to the patient and improving their quality of life.
Moving forward
For healthcare providers, this is a reminder to listen closely to the lived experience of the patient. For patients and families dealing with the relentless exhaustion of chronic hiccups, this research offers validation. It confirms that your struggle is real, it deserves attention, and it requires a compassionate approach that focuses on helping you get your life back- one manageable step at a time.
References:
1. Das A, Halpin S, Kondasinghe JS. Pharmacotherapy for chronic & intractable hiccups in palliative care: A mixed methods systematic & umbrella review. J Pain Symptom Manage.
2. Zugaj MR, Busch C, Züger A, Keßler J. Experience of illness with chronic singultus: A qualitative interview study. Orphanet J Rare Dis. 2025;20(1):141.
Authors
Dr Adarsh Das
Palliative Care and Medical Oncology Advanced Trainee
Palliative Care Service, Sir Charles Gairdner Hospital and Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre
A/Prof Jayamangala Sampath Kondasinghe
Consultant Palliative Care Physician
Palliative Care Service, Sir Charles Gairdner Hospital and Internal Medicine and Faculty of Health and Medical Services, The University of Western Australia