[Invasive tumor pain therapy in the final stage of a cervix cancer patient]

Cancer disease is associated with a lot of very burdening symptoms. Pain is with dyspnea and emesis in the first time in a rate of about 50%, in the terminal stage up to 90% the most tormenting symptom. For more than 90% of patients the 3-step-WHO-regimen for cancer pain is able to relieve pain successfully. But a little group of cancer patients need invasive measures and methods to relieve pain sufficiently. This would be the 4th step, according to the enlarged WHO-regimen. Intravenous or intrathecal applications, eventually regional blockades should be considered. The following case-report shows the steps of a difficult cancer pain therapy in a regional general hospital. It is sometimes not evidence based, on the one hand because of necessary organizational, staff-related, or other makeshifts in daily clinical practice, on the other hand because of the lack of appropriate EBM-guidelines. The pressure to reduce the pain effectively and as simple as possible produces sometimes polypragmatic, retrospective not always satisfying measures.