Managing pain and psychological issues in palliative care.

The management of psychological issues and pain in dying patients have steadily improved. With currently available drugs and techniques, it should be possible for nearly all women with terminal gynaecological cancer to be pain-free. The World Health Organization (WHO) Analgesic Ladder can be effectively utilized for pharmacological treatment of cancer pain. Most side-effects of opioid therapy can be well controlled. Patients whose pain cannot be adequately relieved by systemic opioid therapy may benefit from invasive anaesthetic or neurosurgical techniques. Terminal sedation should be used only after all other therapy has failed. This chapter describes the assessment and management of opioid analgesics and the treatment of their side-effects. Adjuvant analgesic drugs and therapies are also presented.