{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:21:15Z","timestamp":1792686075417,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer pain is a significant public health concern worldwide, necessitating effective management strategies. This study aimed to explore the effects of patient-controlled subcutaneous analgesia (PCSA) with hydromorphone hydrochloride injection on refractory cancer pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study involving patients who received PCSA with hydromorphone hydrochloride injection at our hospital from December 2022 to May 2023. All patients in this study were initially hospitalized to undergo dose titration and safety assessment for subcutaneous hydromorphone PCSA, ensuring drug tolerance and stable pump operation. After achieving dose stabilization, most patients continued analgesic therapy at home using the pump, with dynamic monitoring and dose adjustments conducted via telephone follow-ups and outpatient visits. Pain was assessed using the numerical rating scale (NRS), while anxiety and depression were evaluated using the Edmonton Symptom Assessment Scale (ESAS-R) and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). The incidence of adverse drug reactions was also documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The treatment demonstrated significant improvement across all observed parameters. After the continuous subcutaneous injection of hydromorphone hydrochloride infusion for analgesia,the median NRS pain score decreased from 6 to 1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), the mean sleep quality score decreased from 13.85 to 7.488 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), the median anxiety state score decreased from 5 to 1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), the median depression score decreased from a baseline of 3 to 0.5 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), and the median equivalent oral morphine dose decreased from 140\u2005mg to 52\u2005mg (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PCSA with hydromorphone hydrochloride injection offers significant therapeutic benefits for refractory cancer pain. It effectively reduces pain intensity, decreases opioid dosage, mitigates certain adverse reactions, and is associated with reduced anxiety and depression as well as improved sleep quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpain.2025.1674672","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T06:37:43Z","timestamp":1765953463000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Patient-controlled subcutaneous analgesia with hydromorphone in cancer pain management"],"prefix":"10.3389","volume":"6","author":[{"given":"Zhongkai","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengqing","family":"Jiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","first-page":"409","DOI":"10.3322\/caac.21731","article-title":"Cancer treatment and survivorship statistics, 2022","volume":"72","author":"Miller","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2662","DOI":"10.1200\/JCO.2014.55.8361","article-title":"Cancer survivorship issues: life after treatment and implications for an aging population","volume":"32","author":"Rowland","year":"2014","journal-title":"J Clin Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"591","DOI":"10.3390\/cancers15030591","article-title":"Update on prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis","volume":"15","author":"Snijders","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6838","DOI":"10.3390\/curroncol30070500","article-title":"Cancer pain management: a narrative review of current concepts, strategies, and techniques","volume":"30","author":"Mestdagh","year":"2023","journal-title":"Curr Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"7323581","DOI":"10.1155\/2018\/7323581","article-title":"Patient-controlled intravenous analgesia for advanced cancer patients with pain: a retrospective series study","volume":"2018","author":"Peng","year":"2018","journal-title":"Pain Res Manag"},{"key":"B8","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s40122-023-00507-z","article-title":"Refractory cancer pain and intrathecal therapy: critical review of a systematic review","volume":"12","author":"Mercadante","year":"2023","journal-title":"Pain Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.2147\/JPR.S452605","article-title":"Current status of cognition and clinical practice of refractory cancer pain in Shanghai: a questionnaire survey","volume":"17","author":"Zhang","year":"2024","journal-title":"J Pain Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13229-024-00620-6","article-title":"Structure-function coupling in white matter uncovers the hypoconnectivity in autism spectrum disorder","volume":"15","author":"Qing","year":"2024","journal-title":"Mol Autism"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e191549","DOI":"10.1001\/jamanetworkopen.2019.1549","article-title":"Assessment of health care utilization and cost of targeted drug delivery and conventional medical management vs conventional medical management alone for patients with cancer-related pain","volume":"2","author":"Stearns","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B12","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s00520-018-4368-x","article-title":"Subcutaneous or intravenous opioid administration by patient-controlled analgesia in cancer pain: a systematic literature review","volume":"27","author":"Nijland","year":"2019","journal-title":"Support Care Cancer"},{"key":"B13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s005200000183","article-title":"Hydromorphone: pharmacology and clinical applications in cancer patients","volume":"9","author":"Sarhill","year":"2001","journal-title":"Support Care Cancer"},{"key":"B14","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.vaa.2018.11.001","article-title":"The pharmacokinetics and pharmacodynamics of intravenous hydromorphone in horses","volume":"46","author":"Reed","year":"2019","journal-title":"Vet Anaesth Analg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/S0885-3924(02)00643-7","article-title":"A systematic review of hydromorphone in acute and chronic pain","volume":"25","author":"Quigley","year":"2003","journal-title":"J Pain Symptom Manage"},{"key":"B16","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1016\/j.jpainsymman.2005.01.007","article-title":"Hydromorphone","volume":"29","author":"Murray","year":"2005","journal-title":"J Pain Symptom Manage"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.6004\/jnccn.2020.7699","article-title":"Comparing patient-controlled analgesia versus non-PCA hydromorphone titration for severe cancer pain: a randomized phase III trial","volume":"19","author":"Lin","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1097\/BRS.0b013e3181a90ceb","article-title":"A comparison of three methods of pain control for posterior spinal fusions in adolescent idiopathic scoliosis","volume":"34","author":"Milbrandt","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"977","DOI":"10.6004\/jnccn.2019.0038","article-title":"Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology","volume":"17","author":"Swarm","year":"2019","journal-title":"J Natl Compr Canc Netw"},{"key":"B20","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/S0304-3959(97)03336-8","article-title":"Hydromorphone analgesia after intravenous bolus administration","volume":"71","author":"Coda","year":"1997","journal-title":"Pain"},{"key":"B21","doi-asserted-by":"publisher","first-page":"171","DOI":"10.17085\/apm.24075","article-title":"Optimizing patient-controlled analgesia: a narrative review based on a single center audit process","volume":"19","author":"Oh","year":"2024","journal-title":"Anesth Pain Med (Seoul)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The Edmonton symptom assessment system 25 years later: past, present, and future developments","volume":"53","author":"Hui","year":"2017","journal-title":"J Pain Symptom Manage"},{"key":"B23","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/j.jpainsymman.2009.06.002","article-title":"Establishing \u201cbest practices\u201d for opioid rotation: conclusions of an expert panel","volume":"38","author":"Fine","year":"2009","journal-title":"J Pain Symptom Manage"},{"key":"B25","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1080\/15360288.2021.1920546","article-title":"Subcutaneous patient-controlled analgesia in palliative care","volume":"35","author":"Kondasinghe","year":"2021","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"B26","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.jpainsymman.2023.09.018","article-title":"Patient controlled subcutaneous analgesia of hydromorphone versus morphine to treat moderate and severe cancer pain: a randomized double-blind controlled trial","volume":"67","author":"Zeng","year":"2024","journal-title":"J Pain Symptom Manage"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e01658","DOI":"10.1002\/brb3.1658","article-title":"Risk factors for intracranial infection after craniotomy: a case-control study","volume":"10","author":"Wang","year":"2020","journal-title":"Brain Behav"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.2147\/JPR.S451698","article-title":"Patient-controlled subcutaneous analgesia with hydromorphone versus oral oxycontin for opioid titration of cancer pain: a prospective multicenter randomized trial","volume":"17","author":"Xiao","year":"2024","journal-title":"J Pain Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"562","DOI":"10.4103\/IJPC.IJPC_4_19","article-title":"Cancer pain, anxiety, and depression in admitted patients at a tertiary care hospital: a prospective observational study","volume":"25","author":"Arora","year":"2019","journal-title":"Indian J Palliat Care"},{"key":"B30","doi-asserted-by":"publisher","first-page":"10732748221133752","DOI":"10.1177\/10732748221133752","article-title":"Effects of an intrathecal drug delivery system connected to a subcutaneous port on pain, mood and quality of life in End stage cancer patients: an observational study","volume":"29","author":"Giglio","year":"2022","journal-title":"Cancer Control"},{"key":"B31","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1093\/sleep\/30.6.737","article-title":"The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients","volume":"30","author":"Mystakidou","year":"2007","journal-title":"Sleep"},{"key":"B32","doi-asserted-by":"publisher","first-page":"108712","DOI":"10.5498\/wjp.v15.i10.108712","article-title":"Anxiety and depression in patients with hepatobiliary and pancreatic malignancies: influence of disease stage and psychosocial factors","volume":"15","author":"Yu","year":"2025","journal-title":"World J Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1111\/1759-7714.13819","article-title":"Preoperative predictors of restoration in quality of life after surgery for lung cancer","volume":"12","author":"Ichimura","year":"2021","journal-title":"Thorac Cancer"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1185\/03007995.2010.484723","article-title":"Once-daily OROS hydromorphone ER compared with placebo in opioid-tolerant patients with chronic low back pain","volume":"26","author":"Hale","year":"2010","journal-title":"Curr Med Res Opin"},{"key":"B35","doi-asserted-by":"publisher","first-page":"9201967","DOI":"10.1155\/2020\/9201967","article-title":"Quo Vadis PCA? A review on current concepts, economic considerations, patient-related aspects, and future development with respect to patient-controlled analgesia","volume":"2020","author":"Nardi-Hiebl","year":"2020","journal-title":"Anesthesiol Res Pract"},{"key":"B36","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1177\/1078155220929415","article-title":"Opioid rotation from transdermal fentanyl to continuous subcutaneous hydromorphone in a cachectic patient: a case report and review of the literature","volume":"27","author":"Jackson","year":"2021","journal-title":"J Oncol Pharm Pract"},{"key":"B37","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1038\/clpt.1990.85","article-title":"Morphine and oxycodone hydrochloride in the management of cancer pain","volume":"47","author":"Kalso","year":"1990","journal-title":"Clin Pharmacol Ther"},{"key":"B38","doi-asserted-by":"publisher","first-page":"668930","DOI":"10.3389\/fpsyg.2021.668930","article-title":"Good sleep quality improves the relationship between pain and depression among individuals with chronic pain","volume":"12","author":"Zambelli","year":"2021","journal-title":"Front Psychol"}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2025.1674672\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T06:37:44Z","timestamp":1765953464000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2025.1674672\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":38,"alternative-id":["10.3389\/fpain.2025.1674672"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2025.1674672","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]},"article-number":"1674672"}}