OXFORD, UK-Epidural delivery of opioids effectively relieves pain in patients with advanced cancer who are intolerant of or insensitive to high-dose oral morphine(Drug information on morphine), but improvement in quality of life may be more difficult to achieve, Christopher Glynn, MB, said at a workshop on pain management in palliative care, held at the Vancouver meeting.
For patients with a terminal disease, quality of life might better be termed quality of dying, he said, and for these patients, according to his study results, pain relief alone may not lead to reported improvements in quality of life.
"This finding came as quite a shock," Dr. Glynn said. "We thought that having relieved the pain in these patients, we would have an effect on their quality of life."
Dr. Glynn and his colleagues in the Pain Relief Unit, Churchill Hospital, Oxford, audited the records of 52 cancer patients who had received epidural morphine at home. "All but one died at home with continuous epidural systems in place," he said.
The researchers found few complications with the system. Among all cancer patients sent home with an epidural (probably 50 to 75 a year), "we've had only one infection," he said. "Reinsertion has not been a problem. We've offered to put in an implantable system when catheters fall out, and no patient has required this. They like the simplicity of the system, and its simplicity is its beauty."
In this series, the median starting morphine dose was 10 mg/day and the finishing dose was 30 mg/day, with most patients requiring no more than two or three dose revisions. "Some patients required as much as 200 mg/day, but by and large, daily doses were below 100 mg," Dr. Glynn said. He added that, at these dosages, side effects have not been a problem.
Patients also received bupivicaine at a median dose of 42 mg/day. "Patients have the ability with the syringe driver to boost the bupivicaine dose for incident, or movement-related, pain, to enable them to mobilize," he said. Clonidine(Drug information on clonidine) was added to the regimen for patients with neuropathic pain.