Multiple modalities can be used.

1.     Increase in dosage of round-the-clock analgesia: this may mask moderate exacerbations, but is less likely to help with severe exacerbations. However, there is greater likelihood of side effects from the increased medication levels, particularly when the exacerbation has abated.

2.     Supplemental (?rescue') analgesics:   preparations such as Actiq? which have a rapid onset of action and short duration can be helpful, especially with predictable pain: the lozenge can be taken just ahead of planned activity.

3.     Non-pharmacological measures: changes in body position and movement; massage

4.     Rigorous management of trigger factors: such as constipation, cough etc.

5.     Anticonvulsants: may be the most effective treatment for lancinating pains.

6.     Local techniques: allodynia triggered by light touch (e.g. clothes) may be relieved by application of lidocaine gel.

7.     Cognitive techniques: as described below.