ABSTRACT
This chapter considers all the patient's symptoms and all the information available to doctors and assesses the symptoms, signs and information given using this to choose the appropriate remedies for the problem and offers extra information where available and appropriate. Sometimes the patient continues to experience pain despite assessment and treatment. There are several possibilities. The pain may not have been fully assessed, either because a cue was missed or because the patient did not report having more than one type of pain. An accurate diagnosis is essential for the effective treatment of cancer pain. Making an accurate diagnosis requires an understanding of pathology, anatomy with regard to referred pain, and patterns of metastatic spread. 'Breakthrough pain' is the term used to describe pain that occurs when patients are receiving regular analgesia for pain. There are some basic rules to observe when prescribing an opioid to manage breakthrough pain.
