Abstract
In consideration of the conditions at our university hospital, we produced a cancer pain relief manual. From April 1989 to March 1990 we studied 87 patients who were admitted to this hospital with cancer pain and referred to the pain clinics. The 3-step analgesics ladder of the WHO was adopted as a model. However, the manual differed in the following 4 points: (1) in step 2, buprenorphine was used instead of codein, (2) in steps 2 and 3, we strongly suggested continuous subcutaneous infusion, (3) oral administration was performed 4 times per day, (4) from step 1, combined treatment with nerve block therapy or radiotherapy was considered. The severity of pain was rated on a scale of 0-10. The effectiveness of the pain control was determined from the mean pain score. Relief was effective in every case ; it was extremely effective in 76 cases, effective in 10, and slightly effective in 1. Although the usefulness of this manual was demonstrated by results in almost all patients, there were 11 cases in which pain was not reduced to 0 despite the administration of high doses of morphine. Six of these cases had direct nerve infiltration, and 5 had pain on movement, due to compression fractures of the metastasized thoracolumbar vertebrae. For these, nerve block therapy or radiotherapy diminished severe pain. Buprenorphine has the following advantages: It is not designated as a norcotic drug, and it produces only mild constipation. Its disadvantages are the existence of the ceiling effect and side effects, such as nausea and vomiting. We strongly recommend continuous subcutaneous infusion, because of its convenience, easy adjustability, and safety against infection.
