title: The use of morphine to control pain in advanced cancer: an investigation of clinical usage in Bangladesh.
abstract: In 2007, 13% of all deaths worldwide were due to cancer, and of these 72% occurred in low- and middle-income countries. Opioids are essential for the successful delivery of palliative care and pain control. This paper reports data from a cross-sectional survey that aimed to investigate the use of morphine in advanced cancer in palliative care setting in Bangladesh, in order to inform clinical practice and fledgling service development. The study was a single semi-structured qualitative interview study. Cancer patients, family members and palliative care specialists (20 in total) were interviewed in two medical settings. Transcripts were transcribed verbatim, translated and cross-checked with two local interpreters. Data were imported into NVIVO 8 for coding. A coding frame was generated following line by line coding. Relational codes were established following peer review of coding units and the resulting frame. Despite having been under the pain and palliative care clinics only six out of 10 patients had received morphine. Lack of morphine availability resulted in physical suffering of patients and emotional distress of their families. Lack of availability of morphine was identified as the main barrier to pain control. International attention and collaboration with local policy makers is needed to simplify narcotic regulations and increase the availability of morphine.
authors.affiliation: Gower Street Practice, London, UK. roghieh_dehghan@yahoo.co.uk
authors.forename: Roghieh
authors.initials: R
authors.lastname: Dehghan
authors.forename: Jairam
authors.initials: J
authors.lastname: Ramakrishnan
authors.forename: Nezamuddin
authors.initials: N
authors.lastname: Ahmed
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000600:supply & distribution / Q000627:therapeutic use*; D001459:Bangladesh; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000600:supply & distribution / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D010166:Palliative Care; D011361:Professional Competence / Q000592:standards; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine