How can I assess and manage pain effectively in patients receiving palliative care?

Effective assessment and management of pain in patients receiving palliative care involves a systematic, individualized approach.

First, assess pain directly with the patient whenever possible, as they are the most reliable source of information about their pain experience. Use validated structured pain assessment tools such as the numerical rating scale (0–10) or visual analogue scale to quantify pain severity, differentiating between usual pain, breakthrough pain, incident pain, and end-of-dose failure of analgesia NICE CKS.

For patients unable to communicate effectively (e.g., dementia, learning disabilities), use validated behavioural pain assessment tools to inform management NICE NG31.

Identify and assess all possible causes of pain, including reversible causes such as urinary retention or bone metastases, and consider psychological, social, and spiritual factors influencing pain NICE NG31,NICE CKS,NICE CKS,NICE NG234.

Management should follow a stepwise approach matching analgesic choice to pain severity and patient preferences, starting with non-opioid analgesics (e.g., paracetamol, NSAIDs) for mild pain and progressing to opioids for moderate to severe pain, titrating doses to the minimal effective level NICE CKS,NICE NG61,NICE CKS.

Consider non-pharmacological interventions such as repositioning, environmental adjustments, physical contact, and comfort measures alongside pharmacological treatment NICE NG31,NICE CKS,NICE NG61.

Regularly reassess pain and treatment effectiveness, adjusting the management plan accordingly, and involve the patient and those important to them in decision-making NICE NG31,NICE CKS,NICE CKS,NICE NG234.

Refer to specialist palliative care or pain services if pain is complex, difficult to control, or significantly impacts quality of life NICE NG31,NICE CKS,NICE NG234.