Pain in palliative patients demonstrates impact from many dimensions. This article focuses on pain and typical treatment problems in this respect. A pain analysis is mandatory before initiating pharmacological treatment. However, there are often problems with neuropathic and breakthrough pain. A special issue is the possible toxicity of opioids with acute tolerance and central nervous system sensitisation resulting in increased pain intensity. A key word in the treatment of opioid induced problems is opioid rotation. As pain is very dynamic, close monitoring is recommended.