[Pain relief in the final stage of cancer.]

Most patients with very advanced cancer suffer from severe pain, and many studies have demonstrated how this pain can be sufficiently controlled. It is of great importance to find out if the findings are also true during the final stage of cancer and how the treatment must be adapted. We therefore examined the methods and efficacy of providing pain relief for dying cancer patients. This study included 160 patients with cancer in different sites. The pain treatment and pain severity during the last few days and hours of their lives are described and discussed. Analgesic drugs administered orally in 53% and parenterally in 39% of the patients were the mainstay of therapy. Non-opioid analgesics alone were effective in 10% and in combination with weak opioids in 15% of the patients. In 68% strong opioids were necessary to achieve sufficient pain reduction. Morphine was the most frequently used opioid for 96 patients. Oral doses of morphine were 86+/-60 mg/day (15-240 mg/day), and parenteral doses 89+/-74 mg/day (15-360 mg/d). Additional adjuvant drugs to treat specific types of pain or other symptoms of cancer disease were described for 80% of the patients. Non-pharmacological measures, such as radiation, nerve blocks or neurosurgery, were of no real importance. Only 4% of the patients treated in the way described experienced severe pain during the final stage of cancer. Systemic administration of drugs is very effective in relieving pain in dying patients. No signs of tolerance to opioids could be observed, even in patients who had been taking opioids for a longer period of time (average 39 days).