However, we do know that it is always individual, multi-dimensional and dynamic. Individual quality of life is a complex phenomenon that is not always easy to measure.
Improving individual quality of life is at the heart of palliative care philosophy and practice. Good pain control is not the end-point in itself it is the starting point. Good pain control is not the sole or even primary objective of palliative care per se it is merely a means to an end. 7 This quite proper focus on pain and symptom management may cause confusion in the minds of some observers. The importance of achieving and maintaining an optimal level of pain and symptom control throughout the course of any progressive illness is highlighted in the WHO definition of palliative care. Patient care and outcomes will be enhanced by establishing more formal relationships between these two specialty areas. Each specialty area holds a unique set of skills and competencies, yet there is considerable overlap. Even in circumstances in which palliative medicine and pain services co-exist in the same region, there may be poor integration between the two services. Unfortunately, the availability and accessibility of such services are variable. All such patients with more complex and refractory pain syndromes require a more comprehensive review and many will require interventional therapy and/or adjuvant approaches. In addition, these patients may experience a plethora of unwanted dose-limiting side effects associated with their analgesic medication, sometimes even at low dose. Despite the consistent and rational application of such strategies, it is recognised that a small but significant proportion of cancer patients continue to experience more refractory pain. These guidelines recommend the skilled use of analgesic medications, often in conjunction with a range of adjuvant therapies as may be required.
Thankfully, in most instances, the consistent application of analgesic guidelines, tailored to the unique needs of each individual patient, will deliver a satisfactory outcome. The vast majority of cancer patients will experience pain during the course of their illness.
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