One of the major factors affecting people at the palliative and end of life stages of care is pain management. Dignity and comfort at end of life go hand-in-hand with effective pain management.

Effective pain management also relieves stress and anxiety for friends and relatives.

Our hospice staff identified a specific need to target the issue of pain management and John Taylor Hospice and Heart of England Foundation Trust therefore worked together to establish the Pari Passu pain clinic in 2013.

Pari Passu means ‘equal step’ and the clinic is designed to ensure pain control is in equal step with the rest of a person’s care. The clinic specialises in enabling patients to retain control of pain with proven and effective treatment.

Pari Passu is a joint working project between John Taylor Hospice and the consultant anaesthetists at Heart of England Foundation Trust. Pari Passu gives GPs access to the very best pain expertise for their patients across Birmingham, Sandwell, Solihull and Walsall.

There are many causes of pain in palliative care including:

• Pain from the underlying disease

• Pain from treatments of disease

• Pain from investigations

• Pain from debility

• Pain from co-existing disease or pre-existing chronic pain

• Pain from psychological or psychiatric problems

The majority of palliative care patients have their pain well managed using conventional analgesics and co-analgesics. In 10–20% or more of patients, opioid doses are limited by intolerable side effects which need effective management. About 10% of patients have pain that is more difficult to manage and sometimes benefit from more complex interventions.

Interventional pain management techniques can be highly effective and our Pari Passu service has received high patient satisfaction feedback.

Anaesthetists specialising in cancer pain management have developed minimally invasive techniques to:

• optimise pain control

• minimise side effects, adverse outcomes, and costs

• enhance functional abilities and physical and psychological well-being

• enhance the quality of life for patients.