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

Article Abstract:

When cancer cannot be effectively treated, the task for the physician is to reduce the patient's pain and discomfort as much as possible. Unfortunately, this situation is particularly common in developing countries, where patients often do not see physicians until a tumor has advanced well past the treatable stages. The World Health Organization has proposed an "analgesic ladder" which guides physicians and health workers in the choice of pain killers for untreatable cancer patients. For patients who do not achieve adequate relief from nonsteroidal anti-inflammatory drugs or weak narcotics such as codeine, oral morphine becomes the pain killer of choice. A study of 223 patients with intractable cancer pain was undertaken to determine the effectiveness of the pain relief and the compliance of the patients. Unfortunately, such studies are complicated by the difficulty of obtaining any sort of objective measure of pain. In this study, which took place in India, the problem was compounded by a lack of education among most of the patients. Since most of the patients did not understand the basic concept of a "scale", and thus were unable to communicate the degree of their pain, the authors developed the "Rupee scale". Even the most illiterate were familiar with the rupee, a unit of currency. By identifying the quantitative scale with money, the patients were able to appreciate the scale concept and communicate in a semiquantitative way. The researchers were able to determine that oral morphine was effective in about 91 percent of the cases, and that the side effects are relatively mild, including vomiting, itching, and constipation. Lymphedema and nerve plexus abnormalities were common among the 17 patients who did not achieve adequate pain control, and these conditions may be related. Curiously, nine patients who achieved good pain control refused to continue the oral morphine after discharge, which may be a result of public prejudices and misconceptions about the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Pain, Palliative care, India, Cancer, Cancer treatment, Cancer pain

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Recovery of morphine from a controlled-release preparation: a source of opioid abuse

Article Abstract:

Morphine is a powerful pain killer, but its use is restricted because of the great potential for abuse. One way to circumvent concerns about abuse is to formulate pills in such a way that a pharmaceutical preparation will be less desirable to those with a penchant for narcotic drugs. One commercially available morphine analgesic attempts to do this by incorporating morphine into a time-release pill. Since the morphine is released slowly over a long period of time, it was thought that it would be difficult for a drug abuser to achieve the desired effects with satisfaction. However, a cancer patient with painful squamous cell carcinoma in the jaw revealed to his physicians that the time-release morphine preparation MS-Contin had become a highly desirable drug of abuse. Drug abusers found that it is not difficult to wash away the protective coat from the pill and then crush the remaining pellet. The crushed powder is extracted with a small volume of water, and the powder is separated from the solution with a filter. The solution is then prepared for intravenous injection by the abuser. The authors report this case so that physicians prescribing MS-Contin for legitimate purposes will not be lured into a false belief that the time-release morphine preparation can not be abused. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Dosage and administration, Drug abuse, Morphine habit

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