Despite medical advances over the past 20 years, pain remains a problem in 60% of patients with advanced cancer and other fatal diseases. In this article, we focus on how to assess and diagnose pain, and explore basic pharmacological and other pain-relieving interventions. Important issues highlighted are the need for skilled assessment and timely decisions in getting to grips with pain control quickly. Strategies include the use of the WHO analgesic ladder, effective management of side effects and how to decide which route of drug administration is appropriate in different situations. Alternative treatments for pain, partially or unresponsive to opioids, are outlined and the role of non-pharmacological methods are discussed. Systematic assessment, rapid diagnosis and early effective treatment are crucial. Radiotherapy, chemotherapy and neuroanaesthetic interventions have a role, even in patients with advanced disease. Early referral to specialist palliative care or pain teams is essential for difficult pains or when pain is not quickly controlled. Compassion alone is not enough; competence and effective communication must come first. There is almost always something that can be done to improve the patient's experience. © 2007 Elsevier Ltd. All rights reserved.