As a newly qualified doctor, I have spent the past year involved in an AIDS hospice run by the nuns of Mother Teresa's Order. Recently I was challenged by a 46 year old male patient who presented with severe Kaposi Sarcomas covering large areas of his inner thighs bilaterally and lower legs bilaterally. He was referred for chemotherapy at one of the local hospitals but became a victim of the rapidly deteriorating medical system in South Africa. He was discharged after only several treatments and is left with severe lymphoedema of both legs, testes and penis. He is extremely uncomfortable and in a great deal of pain. Any advice on alleviating his discomfort would be greatly appreciated as I do not believe that further chemotherapy will be available to him in the near future. We have tried treating his pain with morphine syrup but he has had very little response. Thank you for your time.

If chemotherapy is not available, then I assume that radiation therapy is also not availabe. It can sometimes be helpful in these cases, if the lymph nodes are not already irreversibly scarred beyond repair.

Some form of opiate, like morphine, should be effective for this kind of pain if you give enough of it and if he is able to take and absorb oral medications. If he is still awake and in pain, it means you're not giving enough.

Suppositories can also be used, as well as transdermal preparations. We frequently use transdermal fentanyl (known in the U.S. as Duragesic). It's convenient because it works for people who can't swallow medications and you don't need to use injections or IVs. A single patch lasts for 3 days and comes in various strengths. You need to supplement with oral or subcutaneous morphine while you wait to achieve adequate blood levels and until you find the right dose.

I hope this helps. I wish you the best with your new work. I hope it's rewarding for you.

JG