Management of chronic cancer pain using a computerized ambulatory patient-controlled analgesia pump

Chronic pain associated with neoplastic disease can be difficult to treat. The development of a computerized ambulatory, patient-controlled analgesia (PCA) pump may provide the patient and clinician with an alternate approach in management of chronic cancer pain. The pump delivers a constant infusion of analgesic and allows for additional on-command doses for breakthrough pain. Patients with chronic cancer pain poorly controlled with conventional narcotic regimens were eligible for this trial. Four patients were included in this trial. Upon admission, each patient was started on a morphine infusion via a peripheral site and titrated to an effective dose. Once the optimal dose was achieved, the patients were converted to the ambulatory pump. The pump was programmed to deliver identical morphine infusions and any PCA doses. Infusion access was provided by a long-term central venous catheter or subcutaneous infusion set. Final maintenance infusions ranged from 0.8 to 60 mg morphine per hour. Three patients required PCA doses. Patients and family members were trained on catheter care and operation of the infusion pump. At home, patients reported acceptable pain relief while engaging in many activities of daily living. Complications included constipation, possible drug tolerance, and accidental catheter removal. Overall, patient acceptance of the pump was good with improved pain control, minimal adverse reactions, and ease of use at home.