[The control of pain]

As the disease worsens, a patient with incurable cancer runs the risk of suffering pain due to one or more causes. There will be ups and downs but on the whole the pain is likely to get worse. The various components of pain are present and cannot be dissociated: nociceptive sensation, emotional reaction, evaluative reaction. Towards the end of his illness the patient is very likely to evaluate not only the severity of his pain but also its meaning which is often: "I'm getting worse and worse, they can't do anything for me." The experience of specialised centres indicates that it is possible to control pain easily in 85% of patients in need of terminal care. In 10% control is more difficult and requires frequent changes in dose and type of analgesia together with the use of non-drug methods. In 5% pain control is not satisfactory for a number of reasons which are complex and often multiple. For these last two groups specialised multidisciplinary centres are needed but for the great majority of 85% what is needed is competent application of methods which are now well established.