Monday, March 26, 2012

Here's something I never knew before...

When I first started my medical career, the management of terminally ill patients who were in pain involved using a concoction known as a Brompton Cocktail! This was a mixture that had been around for decades, just like "Mixt Abominatum" that was used as a Tonic. Mixt Abominatum relied on the well known medical adage that if it tasted foul, then it must be doing you some good. Nowadays, things have happily moved on.

But back to the Brompton Cocktail: this contained Heroin, Cocaine, Largactil and the alcohol of your choice which was often Brandy. For those of a sweeter tastes, a tincture of orange might be added to make it more palatable. The resultant pain relief was often good, but the hallucinations were pretty difficult to cope with.

Today, Palliative care is a science in it's own right and pain control has come on in leaps and bounds, but Heroin, Morphine and its Opioid derivatives are still regarded as the gold standard in pain relief.

However, several studies published since 2002 suggest that Opioids can stimulate the growth and spread of cancer cells. One study from a group led by Patrick Singleton, PhD, assistant professor of medicine at the University of Chicago Medicine, has shown that lung cancer cells have five to ten times more "opioid receptors" on their surface than do non-cancerous lung cells. Once triggered by opioids that the body produces naturally- endorphines - or by doses of opioids given to relieve pain, these cells then proliferate, migrate and invade at a greater rate.

In another study which used Naltrexone, a drug developed to block the unpleasant side effects of Opioids, it was noticed that terminally ill patients treated with this drug survived months longer than those who did not receive it.

This does not mean that Opioids should not be used to control pain. What it means is that more research needs to be done, and that those who have cancer related pain should talk to their pain specialist and discuss whether Opioids are necessary, and if so, should a Naltrexone-like drug be given to block it's side effects?

As in nearly every field in medicine, we cannot say we have the perfect treatment or the ideal outcome: we are still on the road to discovery, but we're improving all the time.
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