Management of pain in the terminally ill

Patients with life-limiting illness experience many symptoms that can cause discomfort and distress; 30–40% cancer patients with early disease experience pain. This proportion rises to 70–90% in those with advanced illness. Pain can also be a problem in non-cancer diagnoses (e.g. chronic lung disease, heart disease, and advanced neurological disease). All healthcare professionals are likely to encounter patients nearing the end of their lives who present with pain problems; patients may present for interventions requiring anaesthesia and they may be admitted to ICUs. Good pain control in these situations needs adequate assessment and regular review, awareness of the importance of advancing or changing disease, effective dosing and careful choice of analgesic or adjuvant medication, and an absolute need to actively involve both patients and carers in the management of symptoms.