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American Society for Action on Pain

UI - 000078

AU - Swanson G

AU - Smith J

AU - Bulich R

AU - New P

AU - Shiffman R

TI - Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117


AB - Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer

predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology

and developed a system in which patients with severe pain received a continuous narcotic infusion, along

with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related

to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal

narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received

morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid

chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to

the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95%

received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection

and respiratory depression. Progressive pain due to either advancing disease or development of drug

tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion

opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients

with pain related to malignancy can be managed well with this system; and (3) pain control programs can be

designed, implemented, and evaluated in the private practice setting

SO - Journal of Clinical Oncology 1989;7:1903-1908