ABSTRACT
This chapter deals with the specific symptom of pain in the primary palliative care setting. When managing pain it is important to know one’s enemy, so that one may equip oneself with the knowledge and expertise necessary to alleviate this unpleasant symptom. Pain receptors are free nerve endings which are activated by noxious stimuli such as pressure, extremes of temperature and chemical substances such as histamine and prostaglandins to produce so-called nociceptive pain. Neuropathic pain arises when the nerve itself is damaged by compression or infiltration and sends signals of pain to the rest of the nervous system. Tricyclic antidepressants are useful for many pains that are only partially opioid responsive, such as neuropathic pain and chronic pain syndromes, and particularly pain that has a constant, burning or aching nature. Anticonvulsant drugs such as carbamazepine, sodium valproate and gabapentin are useful adjuvants for neuropathic pains, particularly those with a shooting nature.
