Pain Relief: At the present time, all pain relief in Australia is opioid based. The common one used in Australia is Morphine and all preparations of it including slow release formulations, cause dulling of the senses, nausea and significant constipation in almost all (90+%) patients. It also can lead to apathy and not surprisingly depression.

Till a side-effect free drug becomes available that does the same job in pain relief, Palliative Care can NEVER be good in the true sense of the word. However, Morphine even in massive doses, can sometimes not fully control pain especially with bone cancer deposits, and so the patient has to be "tranquillised" out of consciousness with major tranquillisers till they die.

Terminal illness physical problems: where the cancer is situated causes physical problems. Palliative Care cannot hope EVER to control. For instance: Cancer of the lung commonly causes pressure on the airway eventually giving the patient a choking sensation, especially when lying down. The only treatment possible is continuous oxygen and morphine to dull the senses to the lack of oxygen the patient experiences till the patient chokes to death.

Other examples are cancer of the bowel which can cause intestinal obstruction eventually leading to patients vomiting faeces requiring a relieving emergency operation to be performed, and fungating cancers of the face and neck are truly horrific to treat. (Imagine having a huge open wound occupying half your face which exposes the back of your nose and throat as if a rat was eating at it. The smell of these lesions is something to be believed, I can tell you). Bed-sores are very hard to prevent even with the best nursing care.

Morphine dulls all the senses including the skin. The sedative affect of the morphine and reduced skin sensation allows the patient to lie in one place for too long. Blood supply to the pressure areas are decreased over bony points and so the skin dies from lack of blood. Frequent turning, lambswool under blankets and fancy mattresses do help but pressure sores can still develop. The malnourishment and fragile skin from the poor appetite (caused by the morphine) all contribute to pressure sore formation.

"This message is copyright (c) Dr Peter C. Stephenson (1999). No part of this message may be reproduced or published in any print medium without the express permission of the author".