Objective: To determine whether topical benzydamine hydrochloride 3% cream is more effective than placebo in reducing pain related to pressure areas in palliative care patients. Design: Randomized double-blind, placebo-controlled trial. Setting: Three specialist palliative care units in the north of England, with local ethical committee approval for all sites. Subjects: Hospice in-patients with pain related to pressure areas. Interventions: A single application of either benzydamine hydrochloride 3% cream or placebo cream to the painful pressure area. Main outcome measures: Pain assessed using 100 mm VAS, an 11 point numerical pain score and a five-point pain relief score. Results: There was no statistically significant difference between topical benzydamine hydrochloride 3% cream and placebo cream in reducing pain related to pressure areas in palliative care patients. Conclusions: This study does not demonstrate a statistically significant difference between the two treatments. However the study does provide reliable information with respect to the use of different pain measurement tools in late-stage palliative patients. It also provides information regarding the baseline characteristics of this group of patients which may be useful in the planning of any future similar studies.