[Pain Management in Palliative Care]

A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative thoracic oncology. Together with the medicamentous therapy the psychologic and social circumstances of the affected patients have to be considered as factors influencing the experience of pain. The therapeutic fundament according to the WHO guideline for cancer pain is the opiate based medicamentous adjustment combined with non-opioids. In principle, this should be performed preferably orally, as simply as possible, according to a fix drug schedule and individually adjusted to the needed dosage. Breakthrough pain has to be treated with rapidly efficacious, non-retarded analgetics. The typical adverse reaction profile for opiates like constipation and initial nausea should be considered prophylactically by applying concurrent medication with adjuvants. Co-analgesic drugs like anticonvulsiva or corticosteroids could support the analgetic effect and are used preferably in case of neuropathic pain. Primary aim in analgesic therapy is to achieve the best possible pain reduction and hence to safeguard quality of life.