Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology and developed a system in which patients with severe pain received a continuous narcotic infusion, along with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95% received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection and respiratory depression. Progressive pain due to either advancing disease or development of drug tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients with pain related to malignancy can be managed well with this system; and (3) pain control programs can be designed, implemented, and evaluated in the private practice setting.

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