Pain is one of the most feared symptoms of advanced, progressive disease and dying. It is a common but not universal experience in both advanced malignant and non-malignant conditions. A patient-centred approach involving systematic and thorough assessment, management and regular review can provide pain relief for most patients. Even in advanced disease, it is important to identify the underlying cause of the pain. Pharmacological management must be structured around the analgesic ladder, and clear guidance provided.