• Adolf Ofenschüssl and Wilfried Ilias.
• Palliativ-Konsiliardienst des Landesklinikums Weinviertel, Mistelbach-Gänserndorf, Austria. Eadolf.ofenschuessl@mistelbach.lknoe.at.
• Wien Med Wochenschr. 2010 Feb 1; 160 (3-4): 70-76.

AbstractCancer disease is associated with a lot of very burdening symptoms. Pain is with dyspnea and emesis in the first time in a rate of about 50%, in the terminal stage up to 90% the most tormenting symptom. For more than 90% of patients the 3-step-WHO-regimen for cancer pain is able to relieve pain successfully. But a little group of cancer patients need invasive measures and methods to relieve pain sufficiently. This would be the 4th step, according to the enlarged WHO-regimen. Intravenous or intrathecal applications, eventually regional blockades should be considered. The following case-report shows the steps of a difficult cancer pain therapy in a regional general hospital. It is sometimes not evidence based, on the one hand because of necessary organizational, staff-related, or other makeshifts in daily clinical practice, on the other hand because of the lack of appropriate EBM-guidelines. The pressure to reduce the pain effectively and as simple as possible produces sometimes polypragmatic, retrospective not always satisfying measures.

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