Pain control at the end of life.

Pain control at the end of life is almost always achievable regardless of the cause. Most of the principles for managing pain at the end of life are derived from cancer practice. However, this knowledge can be extended to patients with pain from other illnesses at the end of life. Pain assessment is the most important step toward achieving optimal analgesia. It determines the appropriate analgesic therapy; drug dose and route of administration; drug dosing intervals; titration of drug doses; control and prevention of analgesic side effects; and application of adjuvant, loco-regional (nonsystemic), and invasive treatments. A comprehensive approach that integrates patient preferences and management of psychosocial and spiritual/existential components of the patient's pain and suffering with physical components will improve analgesia, reduce the burden of the illness and its treatment, and improve the patient's quality of life.