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Analgesia for patients with advanced disease: I
  1. E J Hall,
  2. N P Sykes
  1. St Christopher’s Hospice, London, UK
  1. Correspondence to:
 Dr Emma J Hall
 St Christopher’s Hospice, 51–59 Lawrie Park Road, Sydenham, London SE26 6DZ, UK;


This series of two articles explores the challenge of managing pain in patients with advanced malignant and non-malignant disease. Pain is a common symptom in advanced disease. Despite guidance from organisations such as the World Health Organisation, cancer pain is often inadequately managed. Managing pain in non-malignant conditions, such as end stage cardiac failure, presents an even greater challenge to healthcare professionals. This first article discusses epidemiology, definitions, pathophysiology, assessment, non-pharmacological approaches, the analgesic “ladder”, and opioids. The second article will examine the use of non-opioids, anaesthetic techniques, and analgesia in dying patients as well as discussing future directions.

  • malignant
  • non-malignant
  • pain
  • opioids
  • analgesia
  • adjuvants
  • non-opioids
  • non-pharmacological
  • EAPC, European Association of Palliative Care
  • NMDA, N-methyl-D aspartate
  • OTFC, oral transmucosal fentanyl citrate
  • SIGN, Scottish Intercollegiate Guidelines Network
  • TENS, transcutaneous nerve stimulation
  • WHO, World Health Organisation

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