Ghooi R B, Ghooi S R
Clinical Research, JK Organization, New Delhi, India.
J Pain Palliat Care Pharmacother. 2003;17(3-4):1-9; discussion 11-2.
The incidence of cancer increases exponentially with age and a large number of cancer patients are the older members of society. In many developing and some developed countries, the disease is usually detected at a stage when it is too late for aggressive anticancer therapy to have the desired effect. Most cancer patients suffer moderate to severe pain during the terminal phase of the disease. This pain is unpredictable and produces fear and anxiety in patients and family members. Morphine is the gold standard analgesic to control this pain, but its availability is restricted. The fear of diversion of morphine for non-medical uses has led to severe control on its availability. Studies have shown that diversion of medical morphine is not really an issue. This paper describes attempts to increase morphine availability through the courts in India. The courts have issued directives to improve the availability of the drug, yet 97% of Indian patients have very poor access to the drug. There is a need to improve access to pain-free end-of-life care. In the absence of morphine, physicians lack experience in its use. They need to be educated to provide for their patients a pain-free life. Patients and their families need to be educated that cancer need not end in a painful death. It is not adequate to be able to manage cancer alone; one needs to free the society from fear of cancer.
癌症发病率随年龄呈指数增长，大量癌症患者是社会中的年长者。在许多发展中国家和一些发达国家，该疾病通常在进行积极抗癌治疗已无法达到预期效果的阶段才被发现。大多数癌症患者在疾病晚期遭受中度至重度疼痛。这种疼痛难以预测，给患者及其家属带来恐惧和焦虑。吗啡是控制这种疼痛的金标准镇痛药，但其可及性受限。对吗啡被转用于非医疗用途的担忧导致对其可及性进行严格管控。研究表明，医用吗啡的转用并非真正的问题。本文描述了在印度通过法院来提高吗啡可及性的尝试。法院已发布指令以改善该药物的可及性，但97%的印度患者获得该药物的机会非常少。有必要改善临终无痛护理的可及性。在缺乏吗啡的情况下，医生缺乏使用经验。需要对他们进行教育，以便为患者提供无痛生活。患者及其家属需要接受教育，了解癌症不一定会以痛苦的死亡告终。仅能治疗癌症是不够的；还需要让社会摆脱对癌症的恐惧。
