Pharmacologic management of nonpain symptoms in surgical patients

Palliative care patients present a variety of devastating physical and psychosocial symptoms in addition to pain and cachexia. One of the main challenges is that these symptoms frequently coexist in any given patient and that treatment administered for the improvement of one particular symptom (e.g., opioids for pain) can aggravate other symptoms, such as nausea or constipation. For this reason it is important to assess multiple symptoms simultaneously in a minimal period of time. In some cases, a careful assessment identifies a number of reversible causes for a specific symptom that can result in rapid and dramatic improvement. In most cases, however, there also are a number of nonreversible causes and symptomatic treatment always has to be considered in these patients. The pathophysiology and treatment of some of these common symptoms are not well understood. There is great need for clinical research on the mechanism and the most effective pharmacologic management. Regular communication with patients and families is of great importance in order to help them adapt to the progressive loss of function, and the necessity of taking multiple medications in order to manage severe symptoms until death.