Management of pain in the terminally ill

Pain is common in terminal illness. It is a multidimensional experience and requires an integrated approach for its management to be successful. Pharmacological treatment follows the World Health Organization pain ladder, with early use of strong opioid analgesia in moderate-to-severe cancer pain. A variety of opioids are now available and choice will be tailored to the individual needs of the patient. Complex pain states, such as neuropathic and cancer-induced bone pain, often require multimodal treatment with adjuvant analgesia and interventional techniques. In the final days of life, drugs will be administered by continuous parenteral infusion, and titrated until symptom control is achieved.