Feature Editor: Jocelyn WhiteThe information and recommendations appearing on this page are appropriate in most instances, but are not a substitute for medical diagnosis. For specific information concerning your personal situation or medical condition, JPM suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to approval by the publisher: Mary Ann Liebert, Inc. To purchase bulk reprints, call 914-740-2100.Opioids are the mainstay of pain management and breathlessness at the end of life. The dose of the opioids needed to manage these symptoms vary among individuals. Very rarely do opioids cause complications when used correctly by your clinician. The following is information about a complication of opioid management that may occur despite proper use. What is Opioid-Induced Neurotoxicity?Opioid-induced neurotoxicity is suspected when the following group of symptoms are present.1. Painful experience from a source that is usually not painful. For example, stroking the arm. 2. Complaints of "all over" body pain, or pain that becomes generalized. 3. Worsening pain without evidence of worsening disease. 4. Involuntary muscle twitching. 5. Confusion, hallucinations, disorientation, and decreased levels of consciousness. 6. Seizures. Why does Opioid-Induced Neurotoxicity Occur?Some of the opioids have active metabolites that are created when the liver processes these opioids. These metabolites are excreted by the kidney and may build up with dehydration and/or decreasing kidney function. Otherwise, it most commonly occurs in response to rapid escalation of opioid medicines used to treat pain or breathlessness. How is Opioid-Induced Neurotoxicity Treated?If it is caused by dehydration, then giving intravenous fluids will reverse the disorder. If it is caused by decreasing kidney function, then reducing the dose of opioid pain medicine usually reverses the disorder.If it occurs because of rapid escalation of the opioid medicine, reducing the dose of the opioid pain medicine or rotating to a different opioid medicine usually reverses the disorder.
rarely used, the laws function as intended, providing autonomy and comfort at the end of life to those with a terminal illness who seek this option. There has been no evidence of the ''slippery slope'' of abuse. To the contrary, there are data that legalizing physician-assisted death has resulted in improvements in end-of-life care. Similar legislation was enacted in Vermont in 2013, and in Montana the state Supreme Court ruled in favor of physician-assisted death. In early 2014, a court decision confirmed that New Mexico doctors can help terminal patients die. Given these developments and that Death with Dignity legislation is presently under consideration in at least seven other states, this is an increasingly important topic for palliative care providers who need to be prepared to answer questions from their patients.
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