Abstract

John S M Leung76085*

Pain is one of the most severe sufferings in advanced and end-stage cancer. Traditionally, we rely on a combination of opioids, Cyclooxygenase (COX) inhibitors and other agents. In the end, the patient is often overwhelmed by drug tolerance so that the drugs fail to relieve the pain but their side effects add to the suffering. Paracetamol (acetaminophen) has been revised from the old concept of being a modest analgesic agent, tentatively grouped among the COX inhibitors, into its own unique class of central acting analgesic agent. Its three routes of administration, oral, rectal and IV injection are found to have comparable efficacy so that for an end-stage cancer patient unable to take in anything by mouth and with limited venous access, the rectal route seems particularly applicable. A preliminary observation is made on the feasibility and efficacy of paracetamol per rectum in two such end-stage cancer patients. Review of the medical literature on the biochemical pathways and pharmacology on paracetamol seems to support such a therapeutic option.