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Ascites-Related Abdominal Wall Pain — SCE Palliative Medicine MCQ

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ModeratePain ManagementAscites-Related Abdominal Wall PainSCE Palliative Medicine

A 72-year-old woman with advanced ovarian cancer develops severe ascites-related abdominal wall pain due to peritoneal stretching. Her pain is constant and worsens with any increase in intra‑abdominal pressure. Which management approach most directly addresses this pain mechanism?

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Correct answer: D — Opioid analgesia combined with therapeutic paracentesis to reduce peritoneal tension

This is nociceptive stretch-mediated pain from ascites. Therapeutic paracentesis addresses the root cause by reducing peritoneal tension, which is shown to relieve symptoms in most patients—particularly those with gynaecological malignancies—while opioid therapy manages the pain itself. NHS Lothian acute oncology guidelines confirm that paracentesis relieves tense abdomen symptoms in the majority, especially in ovarian cancer. NICE MTG9 reaffirms that repeated large-volume paracentesis is standard palliative care for malignant ascites and is effective in approximately 90% of cases. The other options fail to address the mechanical stretch: capsaicin and TENS lack evidence in this setting; gabapentin treats neuropathic pain, which is not specified; intrathecal morphine is invasive and unwarranted when mechanical relief is feasible.

Reference: NHS Lothian acute oncology malignant ascites guidelines (therapeutic paracentesis) and NICE MTG9 peritoneal fluid drainage system (symptomatic relief ~90%)