[Symptom Control at the End of Life]

Symptom Control at the End of Life Abstract. Patients with advanced disease suffer from multiple physical and psychological symptoms. These include pain, weakness, lack of energy, weight loss, breathlessness, nausea and vomiting, constipation, and depression. In the dying phase, death rattle, delirium and terminal agitation may be additional problems. Palliative care focusses on alleviating these symptoms, taking into account the physical, psychological, social and spiritual dimension. Main principles of symptom control in palliative care are 1) considering differential diagnoses of the causes of the symptom to be able to treat potentially reversible causes, 2) using preventive measures and 3) symptomatic treatment - on its own or in combination with causal therapy. The following should be noted regarding pharmacological treatment: In case of permanent symptoms, the drugs have to be given at fixed times, in accordance with their duration of action, to achieve a constant blood level. In addition to this regular drug administration, prn medication should be prescribed, e. g., for pain, breathlessness, and nausea. If oral administration is not possible, drugs can be administered intravenously, subcutaneously or transdermally via patches. Non-pharmacological measures can be used additionally or primarily for symptom control. This paper presents important aspects of symptom control for pain, breathlessness, nausea and vomiting, constipation, and depression as well as for symptoms in the dying phase. It concludes by adding a few words on sedation in palliative care as a measure of last resort.