[Supportive measures in palliation: pain therapy and nutrition]

Pain relief and nutritional support represent two main efforts of palliative medicine. A considerable proportion of surgical patients might not be treated with adequate analgetic medication. Those patients are often treated too late, too short or with an insufficient amount of drug. Particularly if the treatment goal is palliation problems of drug abuse are of less importance. However, randomized trials aiming at best pain relief have rarely been carried out in oncological patients. Psychological factors (suffering, affective aspects) have to be borne in mind when deciding upon pain treatment. The surgeon often knows best the local problem inducing pain whether it is due to intestinal obstruction, infiltration of bone and joints, arising from the viscera, or resulting from nerve compression. This information is of utmost value to select the most appropriate treatment. Parenteral, local, or regional measures to relief pain can be combined with chemical neurolysis. Receptor-specific drugs may be the analgetics of the future. Regarding nutritional support the patient's acceptance must be respected. Other guidelines concern life expectancy, nutritional status, or intestinal function and influence the decision whether or not nutritional support should be offered. Enteral feeding should always be the treatment of first choice due to economical and logistic reasons but also due to the fact that translocation of bacteria and endotoxin can be minimised with this technique.