The term "refractory" can be applied to symptoms that cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not compromise consciousness.
The diagnostic criteria for the designation of a refractory symptom include that the clinician must perceive that further invasive and non-invasive interventions are:
- incapable of providing adequate relief
- associated with excessive and intolerable acute or chronic morbidity, and/or
- unlikely to provide relief within a tolerable time frame."