[Long-term pain control in terminal care with home hospice care]

Ideal pain control in terminal care at home is the usage of oral or rectal administration of analgesics. If these methods of administration cannot manage pain sufficiently, muscular or intravenous injection of analgesics will be necessary. This is the report of a 66-years-old female who had bone metastasis of uterine cervical carcinoma and gait disorder, and had received chemotherapy along with radiotherapy. At her third admission to our hospital, the total radiation done nearly reached the maximum level. We, therefore, administered morphine sulfate (MS contin) for pain control but it induced strong side effects. Therapy was then changed to continuous infusion of morphine hydrochloride using a Baxter infusor. As a result, pain relief was achieved without inducing side effects, and the patient was able to return to care at home. At that time, the patient's remaining life was expected to return to be about 6 months. However, in fact, she was able to survive for 823 days since then, and 637 days (77.4%) of that time was spent at home. This is considered as terminal care performed mainly at home, with subsidiary care at the hospital. The most important factor which contributed to the success of this care was the pain control by an epidural block infusor. In order to realize worth-while care for patients, it is important to offer various treatment programs which can satisfy the needs of patients and their family, and pain control will be one of the most important factors for cancer patients who wish to spend their limited time with their family.