CHRONIC NARCOTIC ADMINISTRATION IN CHRONIC PAIN: PROBLEMS AND PERMISSIVENESS. I.M.C. Clarke, Regional Pain Relief Centre, Hope Hospital, Salford, M6 8HD, England.

The hospice movement has initiated a return to the use of regular oral opioid analgesics for cancer pain.

In spite of increasing confidence with narcotics many medical myths per- sist and inhibit their rational employment. Legal constraints exacerbate this difficulty.

A review is presented based on experience of patients attending a large regional pain relief unit and treated with long-term narcotics.

Reasons for failure of pain relief will be discussed together with an appraisal of the side effects experienced during long-term use of narcotics at moderate and high (>lg. morphine/day) dose levels.

The problem of narcotic administration in patients with chronic non- cancer pain will be considered and more liberal use of these drugs encour- aged in selected patients.

PROTRACTED USE OF BUPRENORPHINE IN CANCER PAIN. A. GOTTLIEB,* L. Marena,* T. Fassio,* (SPON: G. Bragg). Istit Wednesday Nazionale per la Ricerca sul Cancro. V.le Benedetto XV, 10.16132 Genova, ITALY.

[-ZZZT

Aim of Ienvestigation: The great deal of clinical trials on Buprenorphine have been made on acute pain with unique or few administrations especially in post-operative patients. Studies of protracted therapy with Bupren- orphine in patients with severe and lasting pain are still scarce: the authors designed this research to evaluate tolerance in patients submitted to protracted administration of the drug.

Methods: .p In 70 patients with severe cancer pain which resisted to pre- vlous non-narcotic analgesic therapy, Buprenorphine was administered with the aim of abolishing pain. Initial doses were therefore adjusted till this goal was achieved. Afterwards the patients underwent weekly controls and record was taken of the doses of Bupreorphine translated in a six degree scale and of the intensity of pain evaluated on a subjective four degree scale. Doses of Bupreorphine were modified following evolution of pain. A comprehensive score was designed summing up pain intensity scale and Buprenorphine dose-scale for every week of treatment. The evolution in time of this score was taken as a measurement of tolerance.

Results and Conclusion: Untoward effects were also recorded. Bupren- orphine proved to be a very useful drug in managing severe cancer pain. Tolerance to the drug occurred slowly and only rarely did Buprenorphine com- pletely lose its analgesic power. Untoward effects were rare and usually subsided after few days of treatment.