Women with gynecological cancers deserve to have their pain and symptoms managed throughout the course of their illness. This chapter discusses the essentials of pain and symptom management that a physician needs to provide quality primary palliative care for these patients. The first half of this chapter discusses opioids, their conversion, and non-opioid pain management, such as anti-inflammatories and neuropathic pain agents. The rest of the chapter discusses the management of common symptoms, such as depression, constipation, nausea and vomiting, bowel obstruction, ascites, and dyspnea. The discussion emphasizes a practical and systematic approach to symptom management. For example, the recommendation of an antidepressant is based on matching the beneficial side effects to the patients’ other problems. The relative advantages and disadvantages of laxatives are presented to aid in the selection of a laxative the patient will take. Treatment suggestions are offered for refractory constipation. Structured approaches are provided for the management of nausea, vomiting and dyspnea. Treatment options for bowel obstructions and ascites are given in the context of their pathophysiology and based on risks and benefits.
KeywordsPalliative care Pain management Symptom management Comfort care Depression Constipation Bowel obstruction Ascites
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