Pain control in palliative care

Pain is one of the most feared symptoms of advanced, progressive disease and dying. It is a common but not universal experience in both advanced malignant and non-malignant conditions. A patient-centred approach involving systematic and thorough assessment, management and regular review can provide pain relief for most patients. Even in advanced disease, it is important to identify the underlying cause of the pain. Pharmacological management must be structured around the analgesic ladder, and clear guidance provided. Particular emphasis is given to the safe and effective use of strong opioids, including the patient's information needs and the management of unwanted effects. A range of adjuvant drugs is also available, as are interventional techniques and non-pharmacological interventions. Guidance is provided on the reassessment of pain that has not responded adequately to the usual measures, and on indications for specialist referral.