**Abstract**

Pain as an integral part of palliative care (PC) is often present at the end of the life. Today, many different analgesics from opioids and non- opioids origin are in use. The integration of their use is the most effective method for pain relief. The aim of this chapter is to discuss different therapeutic approaches to pain management in palliative care. Palliative care is being confronted between the expectations and the possibilities to provide an efficient relief from the symptoms, the pain and the stress. The possibility to use opioids for pain management, with all side effects, and non-addictive drugs as additional treatment, improves the quality and the duration of life for the patients in palliative care. Since the origin of the pain is different, the use of analgesic therapy should be individualized and adapted to the real need of every person. Finally, only a good organization and institutionalization of palliative care in the society could allow for better prevention of suffering at the end of the life.

**Keywords:** pain in palliative setting, multimodal analgesia, non-opioids, opioids, non-pharmacological therapy

## **1. Introduction**

Pain is an integral part of palliative care (PC) and it is often present at the end of the life. Nowadays the understanding of "palliative care" has changed. The new approach in palliative care services integrates the latest knowledge and developments in medicine [1], providing care by specialized team of doctors for pain treatment, surgery, interventions' radiology, oncology, intern medicines and others. This integration of the knowledge from different specialties, offers in "hospices" a very high-quality care for the patients at the end of their life, where pain is managed by specialized professional teams [2]. This care is enriched with support in daily living, with psychological and spiritual care for patients and their families [3].

The philosophy of palliative care is to provide advanced care planning and support which helps the patient live an active, pain-free life, and the pain treatment is one of the most important curative methods during their habitation in a Hospice. Difficulties with impairments, such as sense of hearing, sight, and speech, often represent barriers in communication. Since the patients in palliative care are elderly persons, they are also burdened with the presence of some neurological diseases such as Alzheimer's disease, dementia, or cognitive impairment, which is an additional problem in this context. Additionally, in patients with cardio-circulatory, respiratory or kidney disorders, symptoms of fatigue, insomnia, and shortness of breath dominate.

Pain is very often present at the end of the life, but unfortunately the presence of pain in palliative care is underestimated. The reasons for that are multi-factorial. One of the reasons is a lack of communication and difficulties between the patients and the palliative care providers; the second is unrecognized and misunderstood presence of pain; the third is the mixture of different symptoms or other reasons [4]. Due to these reasons, it is necessary to improve the knowledge about the pathogenesis of pain and the modern approaches to the management of pain relief.
