Subcutaneous patient-controlled analgesia with hydromorphone for the treatment of refractory cancer pain in older hospitalized patients: a retrospective real-world study - Report - MDSpire
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Subcutaneous patient-controlled analgesia with hydromorphone for the treatment of refractory cancer pain in older hospitalized patients: a retrospective real-world study
Clinical Report: Subcutaneous PCA Using Hydromorphone for Severe Cancer Pain
Overview
This study evaluates the effectiveness and safety of subcutaneous patient-controlled analgesia (PCA) with hydromorphone for managing severe cancer pain in hospitalized elderly patients. The findings indicate a significant reduction in pain scores and a low incidence of adverse events, supporting its use as a viable rescue option.
Background
Managing refractory cancer pain in older adults is challenging due to factors such as dysphagia and fluctuating symptom intensity. Subcutaneous PCA offers a practical alternative when oral opioids are ineffective. This approach allows for rapid titration of analgesia, which is crucial for patients experiencing severe pain.
Data Highlights
Measure
Pre-PCA
24-h Post-PCA
NRS Score
4.43 ± 1.29
2.21 ± 0.73
Mean Reduction
-
2.18 (95% CI 2.05–2.31; p < 0.001)
Response Rate (≥30% improvement)
-
57.3%
Response Rate (≥50% improvement)
-
45.2%
Median Time to Analgesia
-
0.6 h
Key Findings
82% of patients had stage IV cancer.
Mean NRS score decreased significantly from 4.43 to 2.21 at 24 hours.
57.3% of patients experienced a ≥30% improvement in pain.
Adverse events were minimal, with somnolence in 0.4% and constipation in 0.2% of patients.
No cases of respiratory depression were documented.
Clinical Implications
Subcutaneous PCA with hydromorphone can provide rapid and effective pain relief for older patients with refractory cancer pain. Its low incidence of adverse events makes it a safe option for this vulnerable population, warranting consideration in clinical practice.
Conclusion
Subcutaneous PCA with hydromorphone is a promising strategy for managing severe cancer pain in hospitalized older adults, demonstrating significant pain relief with minimal adverse effects. Further prospective studies are needed to validate these findings.
