VIENNA, AustriaEven cancer patients whose pain is well
controlled with regular daily opioids sometimes need rescue doses for
breakthrough pain. For inpatients, this is often done with injected
doses. Hakan Samuelsson, MD, has tested an injector pen that patients
can use for self-administration of rescue doses. A pilot study
suggests that this approach may be a useful option for most patients
who need rescue opioid doses, he reported at the 9th World Congress
The study included seven cancer pain patients who were on maintenance
treatment with stable doses of either trans-dermal fentanyl
(Duragesic) (4 patients) or slow-release morphine (3 patients).
Cartridges of hydromorphone were prepared such that use in the
injector pen provided a dose equivalent to one sixth of the
patients daily opioid dose.
Six patients felt safe with the injector pen and continued the
trial for a mean of 81 days (range, 13 to 191 days), Dr.
Samuelsson reported. The treatment was stopped in one patient
for medicolegal reasons, not further described.
The mean number of injections per day was 4.8 (range, 1 to 18).
Injected doses ranged from 1 mg to 18 mg of hydromorphone.
The users rated handling of the equipment as easy
in seven cases and difficult in one case, Dr.
Samuelsson said. Mechanical injector failure occurred on three occasions.
The researchers concluded that self-administration of subcutaneous
hydro-morphone by an injector pen can offer fast and reliable
relief of breakthrough pain during opioid medication for advanced