Journal of pain and symptom management
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We report an open, uncontrolled study designed to assess the effects of subcutaneous (SC) morphine on dyspnea of terminal cancer. Twenty patients with dyspnea caused by restrictive respiratory failure received an SC dose of morphine of 5 mg (5 patients who were not receiving narcotics), or equivalent to 2.5 times their regular dose (15 patients who were receiving narcotics for pain). Dyspnea (D) and pain (15 cases) were measured before the dose and every 15 min for 150 min after the injection using a visual analog scale 0-100. ⋯ Nineteen of 20 patients (95%) reported improved dyspnea after morphine. We conclude that morphine appears to improve dyspnea without causing a significant deterioration in respiratory function in terminal cancer patients. Double-blind placebo controlled studies are needed in this population.
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J Pain Symptom Manage · Dec 1990
Comparative Study Clinical Trial Controlled Clinical TrialDiscordance between self-report and behavioral pain measures in children aged 3-7 years after surgery.
This study examined concurrent self-reports of pain intensity and behavioral responses in 25 children aged 3-7 yr. Behavioral (Children's Hospital of Eastern Ontario Pain Scale, CHEOPS) and self-report (the Oucher and Analogue Chromatic Continuous Scale) measures of pain were obtained following major surgery. ⋯ Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS. This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children.
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Physician education in cancer pain management is seriously deficient. Many problems occur with opioids simply because of therapeutic ignorance. Opioid side effects are best prevented by using morphine as the drug of first choice for severe pain. ⋯ Physicians need to be aware of how to transfer patients from one opioid to another or from one route of administration to another. Side effects common in clinical practice are constipation, nausea/vomiting, dry mouth, and sedation. The importance of the issues of tolerance, dependence, and respiratory depression have been exaggerated.