Introduction: Pain is one of the most frequent symptoms in palliative care patients. The assessment of pain is sufficiently described for cancer and noncancer patients. In clinical practice visual analogue scales, verbal and numerical rating scales are considered valid to assess pain and used in many palliative care settings. For research purposes multidimensional questionnaires like the McGill Pain Questionnaire and the Brief Pain Inventory are reliable instruments, available in multilingual versions for use in various cultural settings. Problems of pain assessment: In a prospective survey with 1304 patients in our palliative care core documentation project in 2001 in Germany we could show, that palliative care treatment effectively reduced mean physical symptom intensity. Assessment of pain was used for all patients. Self-assessment was available for 454 patients at time of admission and for 243 patients at time of discharge. In patients who died in the unit the performance status deteriorated during inpatient stay, therefore assessment of pain in these patients remained difficult. On the whole, however, pain assessment is not used regularly in all clinical and outpatient settings.
Conclusion: There is a need for ‘‘pain assessment-again’’. Management of pain requires extensive knowledge of pain physiology and assessment, as well as an understanding of pain as a multidimensional experience. Attitudes towards regularly undertaken pain assessment in all care settings and training of healthcare professionals must be improved. There is a need to develop valid, reliable and simple assessment methods for patients who are not able to communicate their pain. Consistent assessment and management of pain remains a challenge for the multidisciplinary team in order to reduce patients’ suffering and improve their quality of life.