Patient-controlled subcutaneous analgesia with hydromorphone in cancer pain management

Cancer pain is a significant public health concern worldwide, necessitating effective management strategies. This study aimed to explore the effects of patient-controlled subcutaneous analgesia (PCSA) with hydromorphone hydrochloride injection on refractory cancer pain.

We conducted a retrospective observational study involving patients who received PCSA with hydromorphone hydrochloride injection at our hospital from December 2022 to May 2023. All patients in this study were initially hospitalized to undergo dose titration and safety assessment for subcutaneous hydromorphone PCSA, ensuring drug tolerance and stable pump operation. After achieving dose stabilization, most patients continued analgesic therapy at home using the pump, with dynamic monitoring and dose adjustments conducted via telephone follow-ups and outpatient visits. Pain was assessed using the numerical rating scale (NRS), while anxiety and depression were evaluated using the Edmonton Symptom Assessment Scale (ESAS-R) and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). The incidence of adverse drug reactions was also documented.

The treatment demonstrated significant improvement across all observed parameters. After the continuous subcutaneous injection of hydromorphone hydrochloride infusion for analgesia,the median NRS pain score decreased from 6 to 1 (p < 0.0001), the mean sleep quality score decreased from 13.85 to 7.488 (p < 0.0001), the median anxiety state score decreased from 5 to 1 (p < 0.0001), the median depression score decreased from a baseline of 3 to 0.5 (p < 0.0001), and the median equivalent oral morphine dose decreased from 140 mg to 52 mg (p < 0.0001).

PCSA with hydromorphone hydrochloride injection offers significant therapeutic benefits for refractory cancer pain. It effectively reduces pain intensity, decreases opioid dosage, mitigates certain adverse reactions, and is associated with reduced anxiety and depression as well as improved sleep quality.