Pain management in palliative care

Pain is an important and under-treated symptom of life- threatening illness. The problem of pain is described and a framework for assessment presented by this article. Clinical assessment, by history, examination and selected special investigation providing the correct diagnosis, facilitates optimal treatment of the symptom. Correct use of analgesic medication, following the guidelines of the WHO step ladder, with the addition of adjuvant analgesics, should control the pain in nearly all cases. Attention should also be given to other aspects of pain, psychosocial or spiritual; sometimes called "total pain". Aspects of non-pharmacological treatment as well as optimal use of analgesic drugs are discussed, with special attention to the use of strong opioid analgesics, like morphine. Some of the side-effects of morphine are addressed, and careful dose titration is encouraged.