Pain management in end-stage cancer is a major challenge

Pain management in end-stage cancer and non-cancer cases is a major challenge as morphine is available only at hospitals and hospice centres and is being very strictly regulated. Over 1.5 lakh new cancer cases are detected every year in India. Only 30 per cent of them are surviving for about five years after diagnosis.

Many of them cannot bear the severe, uncontrolled pain as pain relief medicines like ibuprofen, diclofenac or tramadol are not giving the desired effect.Dr Jean Jacob, palliative care physician at MNJ Institute of Oncology and Regional Cancer Center, explained, “Morphine is a strong medicine and is considered as a ‘gold standard’ for severe pain management. It is available as an oral tablet and also as an injection. Access to morphine for pain relief is a human right. However in India, there is still very limited access to morphine, and the vast majority of the patients with severe pain have no choice but to bear the pain.”

Morphine tablet is the cheapest palliative care option, but an alternative morphine patch is prescribed more often.  Dr S.V.S.S. Prasad, senior medical oncologist at Apollo Hospitals, explained, “Morphine patch can be prescribed to patients and these are small, steady doses which have active ingredients working for a longer period of time. The point is that these patches must be given time to time before the pain starts again. Some of the end-stage patients require four patches a day. For those in home-care, the caregivers have to ensure that the schedules are followed as prescribed by the doctor.”

End-stage patients in cancer and non-cancer cases go through extreme physical stress and anxiety. They are often found to express their feelings like anger, disbelief, fear and loneliness by crying out loud.

Dr Bharesh Dedhia, intensivist and critical care specialist, explained, “Patients suffering with end-stage cancer face immense pain and agony. For them an extended healthcare with a human touch is important. It is very important for the family members to be positive and give them strength.”