ABSTRACT
The importance of pain relief lies at the core of palliative care. Pain is one of the most common symptoms for patients with advanced diseases, yet despite tremendous progress in our understanding of the pathophysiology of pain, many patients worldwide still receive inadequate analgesia. Pain is a complex phenomenon, where psychological, social and spiritual dimensions have a direct effect on the patient's perception of pain. Therefore, effective pain management in general, but in palliative care especially, relies on comprehensive multidimensional assessment of pain that explores its effects on individuals beyond the biomedical model of the disease. Cicely Saunders coined the term total pain in the early 1960s, and to this day this simple yet profound holistic concept of pain holds true. This chapter reviews the pathophysiology of pain, pain assessment and measurement, etiology of pain in advanced illness, and pharmacologic and nonpharmacologic ways of managing pain, and discusses ethical issues concerning pain management in patients with life-limiting illness.
