Intermittent Subcutaneous Opioids for the Management of Cancer Pain

Pain is a very common symptom in patients with advanced cancer, with a prevalence as high as 80%. The vast majority of patients with cancer pain require opioids for its treatment.1,2 Most patients will require alternatives to the oral route for analgesic administration during the course of their disease, due to a variety of factors such as nausea, vomiting, sedation, delirium, bowel obstruction, and swallowing impairment.3 Patients who need parenteral opioids for severe cancer pain usually are managed with intravenous (IV) continuous infusions to maintain stable blood levels due to the short half life of the drugs.4 In order to maintain a continuous opioid infusion, patients managed by palliative care and hospice teams in acute care hospitals, inpatient hospices or at home need to use expensive portable or nonportable pumps, with the added costs of maintenance of a central or peripheral intravenous line and the management of rescue analgesic boluses.2,4 Intermittent IV opioid delivery results in significant sedation and short duration of effect, due to the short half-life of these drugs.4 One alternative is the subcutaneous (SC) route, which offers the possibility of maintaining efficacious pain control with intermittent injections, due to the slower rate of absorption of opioid analgesics.5–7 Intermittent subcutaneous opioid administration with an indwelling subcutaneous butterfly needle is a painless and inexpensive way of achieving pain control in those patients.7–10 The Edmonton Injector is a portable, simple, safe, and inexpensive mechanical device for delivering subcutaneous drugs.11 The purpose of this study is to review the results of intermittent SC opioids in a consecutive series of patients with cancer.