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Show Terminally 111 Get Relief With Drugs Terminally ill poepte need not fear the pain and related symptoms commonly associated with dying as medical care has improved dramatically in the last decade, says a University of Utah pharmacy I professor. "People frequently spend their remaining weeks or months dying instead of living, because they don't have adequate symptom control," says Dr. Arthur G. Llpman, chairman of the department of Pharmacy Practice. "We can now control the majority of symptoms in the vast majority of patients." Speaking at the American Association for the Advancement of Science meeting in Washington, Lipman struck down some misconceptions and gave up-to-date information about drug therapy, to control symptoms in terminal disease. .Pain is the most highly perceived problem, he notes. Its treatment is often a frustrating, controversial, but critical element in many terminal illnesses. "Aggressive narcotic therapy in the terminally ill is frequently indicated," says Lipman. "Narcotics, which work centrally on pain perception, are the cornerstone of therapy for fever, chronic pain that has physical origin." Contrary to a still commonly held belief, heroin does not have an advantage over other narcotic analgesics a fact that's consistently documented in clinical studies, he says. The argument that narcotics inherently result in tolerance and J dependence in patients with advanced, irreversible disease is false, he says. Narcotics rarely lead to treatment-induced dependence in the terminally ill, perhaps because their biochemical makeup differs from those who use narcotics for psychological reasons or intermittent pain. Lipman emphatically discourages using the "Brompton Cocktail," a concoction still used in ' the Untied States which was developed in England during the last century to treat post-thoractomy patients' pain. The mixture contains a narcotic analgesic, local anesthetic, chloroform water and alcohol. "It's an irrational combination that works, but it has no advantages and several disadvantages," he stresses, "among them the potential for drug interactions and dysphoria, the opposite of euphoria. "The dosing regimen was the secret, not the formula, he adds. 'When we use the same dosing procedure reguarly scheduled, by-the clock analgesics we get excellent results with simple narcotics." Giving doses of drugs at regular intervals is logical and more successful relieves pain, notes Lipman. "Rather than wait for pain to return to give another dose, the key is to prevent its recurrence. Waiting until the pain comes back requires larger amounts of drug to treat it." Anti-anxiety agents and antidepressants are not primary drugs"anTTuieir usefulness varies, he says. "We once used these agents routinely, but we're finding that, more often than not, they produce more side effects than benefits." Patients with terminal illnesses often experience common, nagging problems nausea, vomiting, constipation, loss of appetite and treatment-related side effects. When such symptoms are recognzied and treated correctly, relief is striking. The biggest treatment-induced problem is anticholinergic, or side effects, explains Lipman. Dry mouth, blurred vision, urinary retention all are bothersome. But they become critical in patients with terminal disease. "For acute care patients with blurred vision, not reading the newspaper for a while isn't serious," he says. "For someone who's terminal, it's extremely important. These people need as much control and normality in their lives as possible." According to Lipman, the high quality care terminaly ill people now receive is a direct result of advances learned through hospices. Hospice is a philosophical program of care that stresses professional and human obligations to provide symptom control and quality of life. "It's fascinating that what we were seeing and saying 10 years ago was pharmacological heresy. Now it's acceptable," says Lipman. "It's fascinating because science has followed practice, not the other way around." That scientific "body of knowledge" has grown from tremendous research in the phar-macology and pathophysiology of pain, in understanding pain transmission and in work with endorphins the body's own morphine-like chemicals. Recently, issues on symptom control have been increasingly aired at national, 'clinical oncology meetings, he adds. "People who have advanced, terminal disease are generally not afraid of death," relates Lipman. "They fear dying, which is equated with pain, loneliness and loss of control. We can address all three. "With symptom control, we get people out of the pattern of dying and into the pattern of living," he emphasizes. "It's dramatic how frequently and mar-velously jt occurs." |