Der Urologe. Ausg. A
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Symptoms involving the gastrointestinal tract are very common in patients who require palliative treatment. They can be caused by the patient's underlying (malignant) disease or by the treatment of this disease. Nausea and vomiting as well as constipation are of the utmost importance in this context due both to their frequency as well as their complex consequences. A careful evaluation of the patient's history combined with a few diagnostic procedures will help to provide a treatment which is orientated on pathophysiology.
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Terminal illnesses can cause distressing symptoms such as severe pain, mental confusions, feelings of suffocation, and agitation. Despite skilled palliative care in some cases these symptoms may not respond to standard interventions. After all other means to provide comfort and relief to a dying patient have been tried and are unsuccessful, clinical caregivers and patients can consider palliative sedation. ⋯ Palliative sedation is not intended to cause death or shorten life. The patient and family should agree with plans for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.
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The World Health Organization guidelines for cancer pain therapy from 1986 are still valid. A prerequisite for adequate pain palliation is an exact anamnesis and pain diagnosis. A multimodal, staged therapeutic concept then needs to be formulated according to the requirements of the patient. ⋯ In case of persistent pain these are replaced by strong opioids. The availability of new opioids and/or preparations admits a more sophisticated approach to metabolic disorders and specific pain syndromes. Depending on the presenting pain type, co-analgesics might be added.