EVALUATION OF OPIOID USE IN CANCER PATIENTS AT NATIONAL HOSPITAL AND CANCER RESEARCH CENTER, KATHMANDU, NEPAL

Background Nepal is a developing country with an increasing burden of cancer. Coupled with increasing healthcare costs and lack of health insurance, the focus has always been on treatment of cancer, rather than pain or symptom relief. Opioids have recently become more readily available at low costs in Nepal. Aims and Methods The aim of this study was to assess the pain score in patients with advanced stage cancer, and the effectiveness of pain control in these patients with the use of simple opioids in outpatient clinics. Between January and July 2013, patients attending the outpatient clinic in National Hospital and Cancer Research Centre, Kathmandu, with a histological diagnosis of cancer with pain score of two or more (Wong Baker Scale, 0–5), were enrolled in the study following written consent. Patients were started on immediate release morphine 5mg in the outpatient clinic, and pain score was revaluated after one hour and after 2 days, to assess the need for other analgesia. Results 40 patients were included in the study, 42.5% male, mean age of 55±10 years. Pain score out of five was two in 35%, three in 45%, and four in 20% of patients. Patients were given 5mg of immediate release morphine. As expected, after one hour, pain score reduced to one in 27% of patients and two in 73%. Patients were advised to take 5mg immediate release morphine every 4 hours and as required. After 48 hours, the pain intensity was significantly lower than baseline, with one in 22%, two in 35%, three in 39% and four in 2%, and only 48% of the patients required additional analgesia. Conclusion Opioid analgesia remains the standard of care in pain management. It is affordable, easily tolerated and can be delivered in outpatient settings, even in developing countries like Nepal.