1. Discuss your understanding of the concept of pain. Include in your discussion nociception, pain modulation and neuropathic pain. 2. Differentiate epidural and intrathecal administration of analgesia in patients experiencing significant pain 3. Describe your understanding of neurolytic techniques to manage pain. 4. Consider the following list of non-pharmacological approaches to managing pain in patients receiving palliative care, and reflect on how nurses might be able to implement three of these strategies. Jot your ideas down below. • Heat or cold – heat packs can aid relief of chronic musculoskeletal injuries and associated pain. An icepack can be used to help reduce swelling immediately after an injury • Physical therapies – walking, as well as stretching and strengthening or aerobic exercises, may help relieve pain, depending on the cause. Physical activity can also help you stay active and improve your mood. Ask a physiotherapist or osteopath to design a program specifically for your pain condition • Massage – this is better suited to soft tissue injuries and should be avoided if the pain originates in the joints • Acupuncture – a component of traditional Chinese medicine. Acupuncture involves the insertion of thin needles into specific points on the skin and is believed to restore balance, encourage the body to heal itself and release natural pain-relieving compounds within the body (endorphins) • Relaxation and stress management techniques – including meditation and yoga • Transcutaneous electrical nerve stimulation (TENS) therapy – a minute electrical current is passed through the skin via electrodes, prompting a pain-relieving response from the body • Cognitive behavioural therapy (CBT) – this form of therapy can help you learn to change how you think and, in turn, how you feel and behave about pain. This is a valuable strategy for learning to self-manage chronic pain. For tbe majority of patients, cancer pain can be treated using tbe World Healtb Organization cancer pain guidelines; bowever, for 10-20% of patients witb advanced cancer, adequate pain control cannot be acbieved using tbese metbods owing to disease patbopbysiology preventing administration/absorption of pain medications or intolerance due to opioid toxicities. Tbe need to expand analgesic treatment wben oral, transdermal, and Intravenous tberapies fail requires exploration of interventional pain management tecbniques sucb as neuraxial (e.g. epidural and intratbecal) infusion tberapies and neurolytic interventions. Nurses caring for patients witb cancer pain sbould develop tbeir knowledge of tbese multimodal approacbes to cancer pain management. Key words: Cancer pain • Neuraxial (epidural and intratbecal) infusion tberapies # Implantable drug delivery systems (IDDSs) • Neurolytic interventions Marlene E McHugh is Associate Director, Palliative Care Service, Montefiore Medical Center, and Assistant Professor of Clinical Nursing, Columbia University Medical Center (CUMC), New York, NY 10032, USA; Debbie Millei^Saultz is Nurse Practitioner, Beth Israel Medical Center, Adjunct Professor of Nursing, City University of New York, and Assistant Clinical Professor of Nursing, CUMC; Elsa Wuhrman is Nurse Practitioner and Assistant Clinical Professor of Nursing, CUMC; Boleslav Kosharskyy is Assistant Professor of Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine Correspondence to: Marlene E McHugh [email protected] N urses commonly encounter patients witb advanced and terminal illn