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M R Rajagopal

Publications and source records attributed to M R Rajagopal.

15 recordsLinked to original sources
PubMed2003

Intravenous morphine for rapid control of severe cancer pain.

This randomized controlled trial compared intravenous route with oral route for initial dose titration of morphine in 62 patients with end-stage cancer and severe pain. Patients in the intravenous group received 1.5 mg intravenous bolus doses of morphine every ten minutes till pain relief was total or until they became drowsy. After that they got oral morphine at a dose equal to the total initial intravenous requirement four-hourly. Patients in the oral group got oral morphine 5 mg doses (if opioid-naïve) or 10 mg (if already on weak opioid) four-hourly. Patients in both groups had the option to receive rescue doses of their regular oral dose as and when needed, if necessary hourly. Twenty-seven of 31 in the intravenous group had either total or satisfactory pain relief by the end of one hour, whereas only eight of 31 in the oral group had a similar result. After 24 hours and later both groups had similar results. There was no immediate serious side effect in any of the patients. The late side effects were similar in the two groups. In the intravenous group, the ratio of initial intravenous dose requirement to the subsequent regular single oral dose after two days centred around 1:1 (range 1:0.5-1:3.3). This study found the intravenous method to be safe, effective and superior to the traditional method in providing immediate relief to severe cancer pain.

Administration, Oral↗
PubMed2003

Palliative care in India: successes and limitations.

Palliative care in India is in a relatively early stage of development and consequently faces numerous problems. The extent of problems relating to the lack of such care is not well described for cancer or nonmalignant diseases. Opioid availability is seriously limited. Many inexpensive drugs are not readily available and some very expensive drugs are often prescribed, adding to the patients' burden. Enormous psychosocial needs often are neglected in busy clinics. The government's palliative care policy has not been implemented. There are clear needs for improvement in multiple areas that must be addressed as new services develop. A system based on outpatient care has proven cost-effective, empowering families to care for patients at home. Whenever possible, inpatient facility and home visits should be available for those who need them. Some measures of quality assurance should develop concurrent with growth of the palliative care movement. Successes and problems in the development of palliative care in India are discussed.

Analgesics, Opioid↗
PubMed2001

Medical use, misuse, and diversion of opioids in India.

In less-developed countries, opioids such as morphine are often not available for pain relief because of excessive regulations imposed to prevent their misuse and diversion. We describe the effect that these draconian measures have had on the availability of drugs for medical use in Kerala, India, and present results of a study, which we did to ascertain whether or not the misuse and diversion of opioids is as prevalent as the government reaction would suggest. We followed 1723 patients in Calicut, India, who were being treated for pain with oral morphine on an outpatient home-care basis. Over 2 years, we did not identify any instances of misuse or diversion. These results suggest that, in the context of India as a less-developed country, oral morphine can be dispensed safely to patients for use at home. We recommend that palliative care programmes talk to concerned governmental authorities, to make them aware of the medical need for opioids, and communicate with local news media to increase awareness of palliative care and the use of these analgesics. Our project has overcome regulatory barriers that had interrupted availability of morphine and its use in pain relief in India.

Administration, Oral↗
PubMed2000

Intravenous morphine for emergency treatment of cancer pain.

Despite the wide use of the World Health Organization (WHO) analgesic ladder for the relief of cancer pain, it is not uncommon to find patients presenting with severe pain to palliative care centres. This is more so in the developing world, where facilities for pain relief are few and the health care system is not well organized. It has been the practice in a pain and palliative care clinic in south India to give repeated boluses of 1.5 mg of morphine intravenously every 10 min to patients presenting with severe pain. An audit of the procedure was undertaken by a retrospective study of 793 case notes. Seventy-nine per cent of patients had total relief of their pain with intravenous morphine. Three per cent of patients experienced side-effects during the procedure. These included nausea and vomiting, itching, giddiness, restlessness, dyspnoea, chest pain, disorientation and a feeling of uneasiness. Thirty-two per cent of patients had drowsiness, which was one of the end-points of the procedure. It is concluded that intravenous morphine in repeated boluses of 1.5 mg every 10 min is a safe and effective method of managing cancer pain emergencies in a clinical setting in a developing country.

Adolescent↗
PubMed1998

Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna.

Constipation is a frequent cause of distress in advanced cancer. A palliative care unit in Kerala, a southern state of India, conducted a controlled trial comparing a liquid Ayurvedic (herbal) preparation (Misrakasneham) with a conventional laxative tablet (Sofsena) in the management of opioid-induced constipation in patients with advanced cancer. Although there was no statistically significant difference in the apparent degree of laxative action between the two, the results indicate that the small volume of the drug required for effective laxative action, the tolerable taste, the once-daily dose, the acceptable side effect profile, and the low cost make Misrakasneham a good choice for prophylaxis in opioid-induced constipation. There is a need for further studies of Ayurvedic medicines in palliative care.

Adolescent↗
PubMed1997

Palliative home care--the Calicut experience.

A three-year-old palliative care unit in Calicut, in the south Indian state of Kerala, started a home care service in June 1996. This paper reviews the first year of operation of the service; in this period 340 home visits were made. The service aims to deliver palliative care to the patients who are unable to reach the hospital, to empower patients to care for themselves and to empower the family to care for patients. One doctor and a few trained volunteers form the team. In addition to control of physical symptoms and emotional support, the home visits permitted minor procedures including nasogastric intubation, catheterization of bladder, dressing of wounds and intravenous fluid therapy. In some cases, the visits helped to change the attitude of families towards the patients--for example, allaying fear of contagion. In some instances, the visits changed the attitude of the neighbourhood towards the patient for the better. In spite of problems like the distances involved and bad roads, the experience of this team shows that a home care system is possible and essential for delivery of palliative care in India.

Adult↗
PubMed1996

Palliative care in Kerala. Problems at presentation in 440 patients with advanced cancer in a south Indian state.

A new palliative care unit in Kerala, a southern state of India, treated 440 patients' with advanced cancer in the first 15 months of operation. This paper presents an analysis of the problems these patients presented with. Besides the physical problems due to the disease, these patients were found to have a multitude of other concerns peculiar to the region. Lack of financial resources and facilities for follow-up, concerns about the welfare of the family in the absence of proper state-sponsored social security schemes and lack of proper communication between doctors and patients were the major problems that the patients faced. The availability of numerous systems of alternative medicine and a hope for cure even at a late stage of the disease meant that many patients depended on these alternative therapies as their main form of treatment.

Adolescent↗