Cancer, Thai Medicine, And Morphine

[BuckarooBanzai]

Being a sick foreigner in a country it is a little hard to tell what is going on. Living through the final stages of cancer I have been told the limits of morphine dosage are a dose per six hours. Of course no one tells you how much a dose is

General rules that I have found dictate 3-4 hours as the min. between dosages.

Usual Adult Dose for Pain

IV: 4 to 15 mg every 3 to 4 hours as needed. Give very slowly over 4 to 5 minutes. Starting doses up to 15 mg every 4 hours have been used. Chest pain: 2 to 4 mg repeat as necessary

Continuous IV: 0.8 to 10 mg/hour. Maintenance dose: 0.8 to 80 mg/hour. Rates up to 440 mg/hour have been used.

IV patient controlled analgesia or subcutaneous patient controlled analgesia: 1 to 2 mg injected 30 minutes after a standard IV dose of 5 to 20 mg. The lockout period is 6 to 15 minutes. The 4 hour limit is 30 mg.

In a lot of places they have the hen peck box where you push a button to get your own dose.

Morphine is a serious and potentially lethal drug but used appropriately is a god send. The greatly improved manufacturer of the product and the fact that it's effect does not fade with use etc. makes it a much maligned drug in my mind especially in my current condition. My wife is an expert on drugs of all types and she insists I will be a drug addict even though I surely won't be here to witness it.

Sheryl Can You Help Explain all this to me?

Beiing in Thailand I am not going to change Thai ways but I would like to know why their does not seem to be a consensus on use, timing and dosage.

[BuckarooBanzai]

And for those that do not know - a medical dose that you receive does not give you a buzz or make you high - just glorious pain relief and a willingness to fight it out a little bit longer.

Edited February 10, 2013 by BuckarooBanzai

[Sheryl]

Palliative care and pain relief are the weakest areas in Thai medicine, the country is at least 30 years behind the times on this. The beliefs, attitudes and practices that prevail are similiar to what was in the West in the 1960's.

The Patient Controlled Analgesia (PCAs) devices you mention are not AFAIK available here, and the idea of any sort of home IV therapy (let along narcotics) is almost unknown.

Hospitals and doctors vary but it is possible, especially if you consult a pain specialist, for a terminally ill person to obtain reasonably adequate oral pain medications. (They will,m however, insist on using a combination of drugs designed to minimize the amount of narcotic needed).

Towards the end when it reaches the point where the patient can no longer swallow and/or oral medications are insufficient there is presently not much option but to go into a hospital, which is unfortunate for people who wish to die at home.

In hospital, a terminal cancer patient will receive IV morphine. It is readily given in doses and frequency sufficient to keep Thai patients comfortable. Unfortunately the Thais have an unusual sensitivity to all forms of depressent drugs and the dose and frequency that works for them is often not enough for non-Thais (not just Westerners -- even other Asians have this problem in Thai hospitals). Being under the care of a westren trained pain specialist will help.

There is some movement underway, slowly, to bring Thailand into the modern age in palliative care. Within the Thai medical profession, the issue is being discussed more, and there are plans to establish some sort of Palliative Care Center/Hospice affiliated with Mahidol in the Hua Hin area (it will probably be necessary though for patients to stay there, Thailand is still far from being comfortable with the idea of choosing to die at home/allowing IVs etc in the home). Siriraj Hospital now has a palliative care center, and I believe Chulalonghorn Hiospital i has a Pain Center of some sort. There are also some pain specialists at some of the pribvate hospitals in Bkk, and at Khon Kaen Univeristy Hospital.

Depending on where you live I suggest you consult:

Issan:

Dr. Somboon Tienthong at Srinagarind Hospital (KKU). Although it is a government hospital I understand they now have an after-hours arrangement wherev=by you can choose your doctor and encounter less wait time. Dr. Somboon trained in the West and has conducted studies on pain relief.

Bangkok:

Dr. Laksamee Chanvej at Bangkok Hospital Cancer Center (trained in Australia)

Dr. Phornlert Chatrkaw at Chulalongkorn (try through their after hours clinic, or see if they have set up a specialized pain clinic)

The Siriraj Palliative Care Center (sorry I don't kniowany specific doctor names but anyhow it is a Government Hospital so can't choose your doc. However if you an figure out who the best docs there are, they may have private practice elsewhere)

South:

Dr Sakon Singha at Prince of Songkhla Hosp

Aside from narcotics, depending on the type and location of the pain, there are sometimes other measures that can help such as nerve ablation.

Good luck, and please let me know how you get on as this is a problem that arises often in the TV community

[fvw53]

http://www.ehospice.com/ArticlesList/BeforeIdiePublicawarenessofendoflifeinThailand101113054216/tabid/8880/ArticleId/7097/language/en-GB/View.aspx#.UlpcflPVJ7U

Why is there a line going through my text ?

((I suspect you had strikout font selected or before and everything after picked it up - all I did was copy your text and paste as plain text to get rid of it)) - lopburi3

Edited October 13, 2013 by lopburi3

[Dr Robert]

God bless you BuckerooBanzai, may you find the relief you seek,some comfort and peace.