HEALTH - ~ Morphine and pain control

Daniel Hopkins was told six weeks ago that he has advanced lung cancer.
The 85-year-old from Leeds knows his time left islimited, but he has
also hadto cope with terrible pain from the cancer, which hadspread to
his spine.
Treatment with morphine has changed that. He is delighted with his
care at St Gemma's Hospice in Leeds, and hoping to go home soon.
I didn't realise it was possible that medicines existed which could
relieve that level of pain. They have turned my life around."
Anne Jarvis
Patient
He told me: "On a scale of one to ten, the pain was offthe top - it
was excruciating. Now, I don't have any pain at all. It's marvellous."
Those views are echoed by another patient with advanced cancer at St
Gemma's, who is also planning to return home this week.
Anne Jarvis has head and neck cancer and has had her voice-box
removed. She is treated with a slow-release opioid patch.
"My pain was totally debilitating and it made it impossible to think
straight. I didn't realise it was possible that medicines existed
which could relieve that level of pain. They have turned my life
around."
Both are cancer patients but opioids are equally needed to help
patients with a range of other debilitating conditions suchas heart
failure, kidney andrespiratory illness and neurodegenerative
disorders.
New guidance for England and Wales from the health watchdog NICE makes
it clear that pain is being hugely under-treated. It wants doctors to
prescribe opioids, like morphine, more often. The guidance says that
these powerful medicines are often the only means of controlling pain.
I have written more about the guidelines here.
Mike Bennett, St Gemma's professor of palliative medicine at the
University of Leeds, said both doctors and patients needed reassurance
about opioids. He said: "Many doctors share concerns that patients
will become addicted, which is rare."
Natalie Laine says despite great nursing care her husband's death was
not peaceful
The University of Leeds andSt Gemma's Hospice have begun a support
programme for patients starting opioid treatment, which will monitor
and manage symptoms.
Reading the guidance and research in the British Medical Journal, I
was amazed at the apparent scale of under-treatment.
It would appear nearly halfof all patients with advanced cancer do not
have adequate pain controlin addition to others with chronic
debilitating conditions.
He was begging me for help but there was nothing I could do. Stronger
opioids would have made a big difference and dealt as much with his
anxiety as his pain"
Natalie Laine
Wife of patient
Natalie Laine's husband Mark died from motor neurone disease three
years ago at the age of just32.
He had been on opioids for several months. She says he was very
worried about becoming addicted as he knew he would need higher doses
as his disease progressed.
Despite excellent nursing care, Mrs Laine says her husband had a
terrible end."He wanted to be out of it at the end and was extremely
anxious. He was begging me for help but there was nothing I could do.
Stronger opioids wouldhave made a big differenceand dealt as much with
his anxiety as his pain."
The NICE guidance is not specifically about end-of-life care but
rather patientsliving day-to-day with chronic pain. Nonetheless itwill
be another factor which will inform the debate about care for the
dying.
My television report on thisissue is here - just click on the picture
below. My thanks to all those patientsand medical staff who gaveup
their time to enable me to report on this importantissue.
Many patients with advanced cancer and other debilitating conditions
are being "under-treated" for their pain/

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