Patient-controlled analgesic administration: a comparison of steady-state morphine infusions with bolus doses
Article Abstract:
Pain is a common complaint in cancer wards, and may be due either to the effects of malignant disease itself or to side effects of the harsh chemicals used in chemotherapy. Achieving adequate pain relief is not easy, since the optimal dose of pain-killers varies greatly from individual to individual, as does the pain itself. It is not uncommon, therefore, to devise systems by which the patient may control his or her own infusion of morphine. The practice is based on the premise that the patient is the only one who can accurately judge the effectiveness of pain relief and determine where the best balance between analgesia and adverse side effects might lie. However, there is a significant delay between the administration of morphine and the realization of effective pain control. This delay in response, called hysteresis, represents the time it takes for the morphine to diffuse from the bloodstream into the brain, and into the opioid receptors. During this time the plasma levels of morphine are dropping, so it is difficult to standardize a dose based on plasma levels alone. To circumvent this problem, a microprocessor-controlled device was developed that does not administer a bolus of morphine at a signal from the patient, but rather allows the patient to specify effective levels of pain control. The microprocessor then calculates the infusion rate which will help to achieve the level of pain control, taking into account the time for diffusion of injected morphine and the rate of the drug's elimination from the body. In a test involving 35 patients suffering painful mucositis (inflammation of tissues in the mouth) resulting from chemotherapy, the new method of controlled infusion was compared to the more traditional method by which the patient controls individual bolus injections of morphine. It was found that the patients using the microprocessor-controlled devices established superior pain relief. They also used more morphine, but the success of the device was revealed by the fact the these larger doses did not result in greater adverse side effects. The results indicate the patient-controlled continuous infusion with microprocessor-based pharmacokinetic regulation provides superior pain relief for cancer patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Symptomatic treatment versus combination chemotherapy for patients with extensive non-small cell lung cancer
Article Abstract:
Lung cancer of the non-small cell type is more sensitive to radiotherapy than to chemotherapy. But for patients with advanced disease, the cancer has spread too far to be a target for radiation, and chemotherapy remains the only practical treatment. There is some concern, however, that for patients with advanced lung cancer the survival after chemotherapy may be no better than that for patients who are treated only to relieve the symptoms of the disease and make them more comfortable (palliative treatment). To address this issue, a study was conducted to compare chemotherapeutic treatment with purely palliative treatment among 87 patients with inoperable, extensive non-small cell lung cancer. The patients were randomly assigned to receive chemotherapy or not; all patients were treated for symptoms using radiotherapy. A total of 44 patients received chemotherapy and 43 received only symptomatic treatment. There were no statistically significant differences between the survival of the patients who received chemotherapy and the survival of those who did not. By 16 months, all of the patients who received the chemotherapeutic treatment had died, but there were three survivors in the group which did not receive more than palliative treatment. These three patients remain alive after more than 55 months since the initiation of the study. It remains uncertain whether chemotherapy will find a place in the treatment of inoperable lung cancer. Future studies should make an effort to evaluate the effects of treatment on the quality of the patients' remaining time, as well as on the length of that time. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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