Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center

Vijayaram, S.; Ramamani, PV; Chandrashekhar, N. S.; Sudharshan, R.; Heranjal, Roshini; Lobo, Bridget; Obedullah, D.; Bhargava, Manorama

doi:10.1002/1097-0142(19901001)66:7<1590::aid-cncr2820660725>3.0.co;2-r

Cited by 19 publications

(4 citation statements)

References 6 publications

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“…The pharmacological treatment approach used in this study for pain control was effective, feasible, and satisfactorily relieved symptoms in 179/184 (97%) episodes. These results are similar to other reports from developing countries 25. Children and adolescents with cancer worldwide can and have the right to have their pain relieved.…”

Section: Discussionsupporting

confidence: 91%

Clinical aspects and treatment of pain in children and adolescents with cancer

Caran¹,

Dias²,

Seber³

et al. 2005

Pediatric Blood & Cancer

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Section: Discussionsupporting

confidence: 91%

Clinical aspects and treatment of pain in children and adolescents with cancer

Caran¹,

Dias²,

Seber³

et al. 2005

Pediatric Blood & Cancer

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“…In morphine‐naïve cancer patients a mean titration duration of 4 days was reportedly required to achieve satisfactory pain control, although the procedures for morphine titration were not described 13. In patients previously treated with weak opioids, the mean titration time to achieve adequate analgesia using a 33–50% increment each day was reported to be 2.3 days, despite patients presenting with low levels of pain intensity 2…”

Section: Discussionmentioning

confidence: 99%

Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion

Mercadante

Villari

Ferrera

et al. 2002

Cancer

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BACKGROUND Cancer pain emergencies presenting with severe excruciating pain require a rapid application of powerful analgesic strategies. The aim of the current study was to evaluate a method of rapid titration with intravenous morphine to achieve relief of cancer pain of severe intensity. METHODS Forty‐nine consecutive patients admitted to a Pain Relief and Palliative Care Unit for severe and prolonged pain were enrolled in the study. Pain was evaluated on a numeric scale of 0–10 (0 indicated no pain and 10 indicated excruciating pain). After the initial assessment (T0), an intravenous line was inserted and boluses of morphine (2 mg every 2 minutes) were given until the initial signs of significant analgesia were detected or severe adverse effects occurred (T1). A continuous reassessment was warranted and the effective total dose administrated intravenously was assumed to last approximately 4 hours and was calculated for 24 hours. The dose immediately was converted to oral morphine (a 1:3 ratio for low doses and a 1:2 ratio for high doses). RESULTS Data from 45 patients was analyzed. A significant decrease in pain intensity was achieved in a mean of 9.7 minutes (95% confidence interval [95% CI], 7.4–12.1 minutes), using a mean dose of intravenous morphine of 8.5 mg (95% CI, 6.5–10.5 mg). The doses administered rapidly were converted to oral morphine and pain control was mantained until the patient's discharge, which occurred in a mean of 4.6 days (95% CI, 4.1–5.2 days). The incidence of adverse effects was minimal. CONCLUSIONS The results of the current study demonstrate that cancer pain emergencies can be treated rapidly in the majority of cancer patients with an acceptable level of adverse effects. Intravenous administration of morphine requires initial close supervision and continuity of medical and nursing care. Cancer 2002;95:203–8. © 2002 American Cancer Society. DOI 10.1002/cncr.10636

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“…That severe pain in Indian cancer patients can be relieved with oral morphine solution has been demonstrated. In a prospective study of 223 patients, 14 it was shown that most patients achieved pain relief in about 4 days, and pain relief was maintained in over 90% of patients at follow-up of 4 to 16 months. Only 30% of patients reported side effects, and of those patients, only three had side effects that required discontinuation of morphine.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

The Assessment of Cancer Pain in North India

Saxena

Mendoza

Cleeland

1999

Journal of Pain and Symptom Management

102

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The status of pain treatment for cancer patients in India is largely undocumented. Although many languages and dialects are spoken throughout the country, millions of persons in North India speak Hindi. This project developed and validated a Hindi version of the Brief Pain Inventory (BPI-H), a short measure of pain and pain interference that has been shown to be relatively free of cultural or linguistic influences. In the validation process, we were able to administer both the Hindi and English versions of the BPI to a sample of bilingual (Hindi and English) patients. The English and Hindi versions of the BPI were very similar in their psychometric properties, supporting the reliability and construct validity of the Hindi version. As with other language versions of the BPI, factor analysis of the BPI-H items results in severity and interference subscales. We followed the validation with an examination of the status of cancer pain management in a major northern Indian cancer center, based on 200 patients with pain who spoke only Hindi. Using a conservative measure of analgesic prescription adequacy (the Pain Management Index), three-fourths of Hindi-speaking cancer patients in this study were inadequately treated by World Health Organization (WHO) recommendations. The results of this study encourage the development of other forms of the BPI in the many languages of India, and the use of the instrument in studies of the epidemiology and treatment of cancer pain.

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Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center

Cited by 19 publications

References 6 publications

Clinical aspects and treatment of pain in children and adolescents with cancer

Clinical aspects and treatment of pain in children and adolescents with cancer

Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion

The Assessment of Cancer Pain in North India

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