E. Spoldi

Hyperalgesia and myoclonus with intrathecal infusion of high-dose morphine

We report the case of a patient who developed myoclonus and hyperalgesia following administration of high-dose subarachnoid morphine. This complication occurred with 40-80 mg/day continuous infusion. The pathophysiology of these side effects is discussed.

Octreotide in relieving gastrointestinal symptoms due to bowel obstruction

Gastrointestinal obstruction is a common problem in advanced malignant disease, but its management remains controversial. In those patients for whom surgery is not appropriate, medical intervention is the only remaining option. We present a series of 14 patients with intestinal obstruction who were managed with subcutaneous injections of octreotide, a somatostatin analogue which reduces the volume of gastrointestinal secretions. Good control of vomiting was achieved in 12 patients, and no major side effects were observed. Octreotide would appear to be a useful drug in this clinical situation.

Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction

We describe the use of hyoscine butylbromide as a subcutaneous infusion in 3 patients with inoperable malignant bowel obstruction. An objective reduction of drainage from the gastrointestinal tract was observed with the hyoscine butylbromide infusion (60-120 mg/day). We suggest that this effect can be useful in the palliative treatment of vomiting in inoperable bowel obstruction.

A retrospective study on the use of oral morphine in cancer pain

Abstract The authors report a retrospective study of 390 cancer pain patients tested with oral morphine during a four-month period. Initial pain scores were reduced to one half after one week of treatment and then maintained throughout the study period. Mean daily dosages of morphine were lower in those patients 65 years and older. No significant changes in performance in relation to therapy were noted except for an increase in hours of sleep. An accurate titration of dosage and continued control of side effects are the main requirements of this method of administration. The presence of side effects and the cause of interruption of treatment are reported.

Symptom Control in Palliative Home Care

The control of symptoms other than pain, in the home setting as in the hospital, is of special importance in the terminal phase of oncological diseases, as these disorders accelerate and make the approach to death even more difficult [1].

Analgesic Drugs in Palliative Care

Palliative care consists of a new way of supporting the terminally ill who prove unresponsive to specific antitumor treatment to improve their quality of survival. By quality of survival we mean the psychosocial, environmental, and physical conditions of the individual which deteriorate during the advanced and terminal phases of cancer. It is a multidisciplinary approach, encompassing the patient, the family, and the community in its scope.

Cancer Pain Management and Drug Delivery

According to WHO reports [1,2], every year 5.9 million people are diagnosed as having cancer and 4.3 million of them die of the disease. A major contribution comes from the developing countries: 50% of the diagnosed cases and two-thirds of the deaths are recorded in these nations. In a review of the international literature, pain was found to be a major symptom in 70% of the advanced cancer patients [3]. Pain is moderate to severe in about 50% of the patients and severe or excruciating in 30% [4]. Cancer pain is often inadequately treated: reports from different countries indicate that 50% to 80% of the patients do not get satisfactory pain relief [3]. One of the main reasons for the persistence of pain is the widespread attitude among physicians and nurses against an adequate use of analgesics, in particular of opioids [5]. Fear of addiction, ignorance of the principles of analgesic titration and unavailability of drugs due to logistic and legal barriers are other important aspects of the pain problem. In 1982, the World Health Organisation outlined an important policy on this subject, and following consultations with the experts on cancer pain, a method of using analgesics was drawn up and published in 1986 [6].