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Palliative Care Guidelines - Pain Management


  • Assess each pain fully before starting or changing analgesics; use a pain assessment tool
  • Record a pain score and review the patient regularly
  • Physical pain types include: nociceptive pain, neuropathic (nerve) pain, nerve pain, bone pain and episodic pain
  • Patients with pain may also have significant emotional, social or spiritual problems
  • Agree goals for pain management with patient and family

  • Morphine remains the first line opioid for moderate to severe pain
  • Prescribe regular analgesia for continuous pain
  • Most people taking regular opioids need a laxative
  • Renal and hepatic impairment affect opioid metabolism and excretion - see guidelines on choosing and changing opioids
  • Analgesics with an antipyretic affect (paracetamol, NSAID) can mask fever in neutropenic sepsis. Patients receiving chemotherapy should be monitored carefully if they are taking these medications and told to seek advice if they become unwell.
  • Paracetamol is recommended first line for mild to moderate pain. The maximum 24 hour dose for adults is 4g but this should be reduced in patients with a low body mass index or severe liver impairment due to chronic alcohol dependence. Regular paracetamol may not improve analgesia in patients also receiving regular strong opioids.

Related Guidelines:

Patient Information Leaflets

Web Resources:

Pain Management Guideline
SIGN 106 Guideline
NHS QIS Pain Management Standards


NHS 24 Website