Table 71 Principles of symptom management

Determine the cause. Treat simply.

Provide appropriate explanation of symptoms and treatment. Provide regular review.

Give medication regularly around the clock, not ad hoc. Plan 'breakthrough' pain-relieving doses. Provide physical treatment as necessary e.g. paracentesis, pleural tap, nerve block. Provide complementary conservative therapy e.g. massage, physiotherapy, occupational therapy, dietary advice, relaxation therapy. Provide close supervision.

Fig. 7.1 Stages of cancer management: the goals of treatment differ according to the different stages AFTER J. BUCHANAN ET AL.

Pain control in cancer

Achieving pain relief is one of the most important functions of palliative care and patients need reassurance that they can expect such relief. The principles of relief of cancer pain are: 1

1. Treat the cancer.

2. Raise the pain threshold:

o Provide appropriate explanation. o Allow the patient to ventilate feelings and concepts. o Give good psychosocial support. o Use antidepressants or hypnotics.

3. Add analgesics according to level of pain, e.g. opioids (if necessary).

4. Use specific drugs for specific pain—not all pain responds to analgesics (refer Table 7.2).

5. Set realistic goals.

6. Organise supervision of pain control.

Note: The right drug, in the right dose, given at the right time relieves 80-90% of the pain. 1

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