Der Schmerz
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The efficacy of morphine and other opioids in the treatment of severe pain, especially cancer pain, is undoubted. If opioids are used according to the WHO guidelines no severe side effects or psychological dependence develop. In Germany the use of strong opioids is controlled by law and requires a special prescription with offical forms and difficult regulations. ⋯ The prescription patterns we found demonstrate inadequate medical care of patients with severe pain. Continuous pain therapy with strong opioids was found in only a few cases. The main reason for this situation is the law pertaining the use of opioid drugs, with its difficult and restrictive regulations. This law cannot stop the development of increasing illegal drug consumption, but obstructs the medical care of patients with severe pain.
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Opioids have been used for analgesia in nearly all civilizations. In paediatrics their use has become widely accepted for combating severe pain, especially postoperative pain and tumour pain. Receptors in the central nervous system are the best known sites of action of opioids, but the existence of peripheral receptors is also probable. ⋯ Tramadol is widely used for emergencies, as it has the least sedative action; but it has disadvantages in causing nausea and vomiting. Codeine is widely used for its antitussive action. While the necessity of good analgesia for even the smallest infant cannot be overstated, the opioid used must be carefully selected with reference to the age of the child and the pain to be controlled.
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In the pain treatment of patients with incurable head and neck tumors it may be difficult to provide adequate oral drug therapy in the advanced stages. In these cases continuous subcutaneous application of morphine by means of external infusors is an alternative. An example of the method of continuous subcutaneous application of analgesics in pain therapy is shown in a patient suffering from a chondrosarcoma of the maxilla. ⋯ Because of growing tumor infiltration, we progressively increased the morphine dosage. Nevertheless, continous subcutaneous application of droperidol, dexamethasone and clonidine was also needed to achieve much better analgesia. The technical simplicity of this safe and effective treatment make it suitable for outpatient care in tumor clinics.