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Defining refractory symptoms — A symptom is considered "refractory" when it cannot adequately be controlled by therapies that do not seriously compromise consciousness and when it is associated with intolerable suffering on the part of the patient. The diagnostic criteria for "refractoriness" are based on the clinician’s determination that further invasive and noninvasive interventions meet any of the following [1]:
●Incapable of providing adequate relief
●Associated with excessive and intolerable acute or chronic adverse effects
●Unlikely to provide relief within a tolerable time frame
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USUSALLY MIDAZ IVI
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