20.3 Symptom management
These patients often experience pain, which can be of multifactorial origin but frequently affects skeletal muscle and which can be aggravated by the presence of the LT-MCS device. For pain management, opioids have advantages over non-steroidal anti-inflammatory drugs, since the latter affect renal function and volume status and increase the risk of GI bleeding. Mood disorders such as anxiety and depression are very common as well, the treatment of which, whether pharmacological or otherwise, may require referral to a mental health specialist. In such cases there can be a risk of suicide, because the patient has direct access to the life-supporting device [502]. Other frequent symptoms that must be addressed include anorexia, constipation and insomnia.