Lange 1995 {published data only} Lange A. Physiotherapy in cancer treatment-therapy for tumour or therapy limited to functional restriction due to malignant disease [Physiotherapie in der Onkologie-Behandlung von tumor oder therapie-bedingten Funktionsstorungen bei malignen Erkrankungen]. Krankengymnastique 1995;47(3):338. Librach 1988 {published data only} Librach SL. The use of TENS for the relief of pain in palliative care.

This larger dataset supports a clinically important difference of 10mm. Studies should be powered to detect this difference.

AimsTo assess the effect of oral opioids vs. placebo on breathlessness in patients with chronic heart failure (CHF). Methods and resultsOral morphine (Oramorph), oral oxycodone (Oxynorm), and placebo were studied in an outpatient setting. Once randomized, participants received all three interventions in a controlled double-blind crossover trial for 4 days each, with a 3-day washout between interventions. Patients known to the Hull and East Yorkshire Academic Cardiology department with CHF (New York Heart Association Grade III -IV) were invited to participate. Participants were eligible if they were on standard medical therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and diuretics.Participant-rated change in 11-point numerical rating scale (NRS) (average over previous 24 h) breathlessness severity score from baseline (Day 1) to Day 4 of treatment was the primary outcome measure. The study was powered to detect a one-point change in severity.Thirty-nine patients were randomized and 35 completed all three study arms. Breathlessness severity was reduced from baseline with all three interventions. There was no statistically significant difference between active intervention and placebo or between the two types of opioid for the primary endpoint [21.37 in NRS score for placebo group vs. 20.41 in morphine group (P ¼ 0.13) and 21.29 for oxycodone group (P ¼ 0.90)]. The response to treatment was not affected by aetiology, severity of CHF, or concurrent drug therapy. Opioid administration did not cause detrimental changes in clinical observations and was well tolerated. ConclusionWe demonstrated no benefit over placebo for the relief of breathlessness with short-term low-dose oral opioids for CHF patients.Trial registered prior to the recruitment of the first participant with Current Controlled Trials (www.controlled-

Chronic refractory breathlessness is common and distressing in advanced disease. Despite level I evidence to support the use of opioids for this symptom, not all patients benefit. This study aimed to discover which patient characteristics predict those most likely to gain improvement in breathlessness. This is an international, multicentre, retrospective analysis of 213 individual pooled datasets from four clinical trials of an opioid for chronic refractory breathlessness. ''Response to opioid'' was defined as 1) an absolute value of o10 mm improvement on the visual analogue scale (VAS) and 2) a relative value of o10% improvement from baseline VAS. We investigated baseline predictors using logistic regression.In the final model, higher baseline breathlessness intensity scores strongly predicted absolute and relative response (p,0.001). Younger age also predicted relative response (p50.025); functional status and dominant cause of breathlessness did not. Some evidence supported the descriptor ''not enough air'', but was not statistically significant (p50.052).A therapeutic trial of opioids is appropriate, irrespective of the cause of the breathlessness or functional status. Younger people or those with worse breathlessness are more likely to benefit. Opioids have a role in the management of chronic refractory breathlessness, but net benefit for individuals must be optimised. @ERSpublications A role for opioids in the management of chronic refractory breathlessness; net benefit for individuals must be optimised

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