Driving ability in cancer patients receiving long-term morphine analgesia

Vainio, Anneli; Rosenberg, P. H.; Kalso, Eija; Ollila, Juhani; Matikainen, Esko

doi:10.1016/s0140-6736(95)92281-4

Cited by 212 publications

(98 citation statements)

References 15 publications

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“…9 Our data also suggest that delirium was preventable/reversable if exposure to opioid medications was kept as low as possible. Although cognitive function seems to be preserved in patients taking moderate doses of opioids for chronic pain, 26,27 the documentation of the effect of high doses of opioids on cognitive function remains incomplete. Our current and past work 2 in the field of drug-induced delirium has helped to identify a critical threshold of daily exposure to opioid medications (90 mg of morphine) above which the risk of delirium significantly increases.…”

Section: Discussionmentioning

confidence: 99%

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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BACKGROUND.Delirium is an important problem in hospitalized cancer patients. The objective of this study was to determine whether exposure to corticosteroids, benzodiazepines, or opioids predicted delirium.METHODS.A prospective cohort study was conducted in an oncology/internal medicine population. Patients were assessed continuously for the presence of delirium until they were discharged by using the Nursing Delirium Screening Scale (Nu‐DESC). Follow‐up for outcome began after incident delirium. The primary outcome was the presence of a delirium event, which was defined as a Nu‐DESC score >1. Strengths of associations of medications with delirium were expressed as odds ratios (ORs) in univariate and multivariate analyses.RESULTS.In total, 114 patients (1823 patient‐days) met the inclusion criteria for the study. The mean follow‐up from incident delirium was 16 days. The mean number of delirium events by patient was 6 (total number, 667 delirium events). Analysis by day on several occasions revealed significant associations between opioids and delirium. Corticosteroids and benzodiazepines were not associated significantly with an increased risk of delirium on any given day. Analysis by patient using generalized estimating equation (GEE) models showed an increased risk of delirium on any day of follow‐up associated with opioid exposure in univariate analysis (OR of 1.70; P < .0001). The association remained significant after adjustment for corticosteroid, benzodiazepine, and antipsychotic exposure using GEE regressions (OR of 1.37; P = .0033). Truncating follow‐up at 30 days did not affect the results (OR of 1.38; P < .032).CONCLUSIONS.Exposure to opioids during hospitalization was associated significantly with an increased longitudinal risk of delirium. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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“…For most patients receiving stable doses of morphine effects on cognitive and psychomotor function are minimal. In particular, there are data indicating that patients' driving ability is not significantly impaired, in alert patients receiving a stable dose (Vainio et al, 1995). Similarly, nausea and vomiting, which occur in up to two-thirds of patients when morphine is started, usually resolve.…”

Section: Unfounded Fears Associated With Morphinementioning

confidence: 99%

Morphine and alternative opioids in cancer pain: the EAPC recommendations

et al. 2001

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Summary An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated. http://www.bjcancer.com Daytime drowsiness, dizziness or mental clouding commonly occur at the start of treatment but resolve when patients are stabilized (usually within a few days). For most patients receiving stable doses of morphine effects on cognitive and psychomotor function are minimal. In particular, there are data indicating that patients' driving ability is not significantly impaired, in alert patients receiving a stable dose (Vainio et al, 1995). Similarly, nausea and vomiting, which occur in up to two-thirds of patients when morphine is started, usually resolve. The main continuing adverse effect from morphine is constipation, and the prophylactic use of a laxative is almost always required. Morphine: limitationsThe systemic availability of morphine by the oral route is poor (20-30%) and this contributes to a sometimes unpredictable onset of action and great interindividual variability in dose requirements and response (Glare and Walsh, 1991). Active metabolites may contribute to toxicity, particularly in patients with renal impairment (McQuay and Moore, 1997). And some types of pain do not always respond well or completely to morphine, notably neuropathic pain. However, none of the alternatives to morphine has so far demonstrated advantages which would make it preferable as the first line oral opioid for cancer pain. Morphine remains our first choice but for reasons of familiarity, availability and cost rather than proven superiority.2. The optimal route of administration of morphine is by mouth. Ideally, two types of formulation are required: normal release (for dose titration) and modified release (for maintenance treatment) CThe oral route is the simplest and most acceptable to patients.There is large interindividual variation in kinetics (Säwe, 1986) and dynamics in cancer patients whose pain will also vary in severity so that the dose must be titrated against effect for each patient, and the starting dose will be determined by previous analgesic treatment. Patients changing from regular administration of a step 2 opioid (in combination with a non-opioid) will usually start with 10 mg every 4 hours. If step 2 of the analgesic ladder is omitted 5 mg every 4 hours may suffice, whereas patients converted from another step 3 opioid will require more. During dose titration it is preferable to use a formulation of morphine that has a rapid onset and a short duration of action to allow steady state to be achieved as quic...

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“…ont conclu qu'un traitement stable de longue durée aux opioïdes n'influence pas la performance psychomotrice, comme celle de conduire une automobile, de façon telle que cela pourrait la rendre dangereuse. 11 Haythornthwaite et coll. ont démontré qu'il n'y a pas de détérioration de la fonction cognitive chez des malades qui souffrent de douleurs chroniques non cancéreuses pendant un traitement aux opioïdes à action prolongée.…”

Section: Ces Craintes Et Suppositions Sont-elles Fondées?unclassified

“…10 Vainio et al have concluded that long-term stable opioid therapy does not effect psychomotor performance such that driving would be hazardous. 11 Haythornthwaite et al have demonstrated no deterioration in cognitive function in patients with chronic non-cancer pain during long-acting opioid treatment. They also showed improvement in sustained attention and psychomotor speed associated with the decrease in pain intensity as a result of opioid use.…”

mentioning

confidence: 98%