Morphine for the relief of breathlessness in patients with chronic heart failure—a pilot study

Abstract

Background: Chronic heart failure (CHF) patients can experience significant breathlessness despite maximum medication for their heart failure. Morphine has long been used to relieve symptoms in acute failure, but there is little evidence about this potentially useful palliative therapy in CHF. Aims: To determine the efficacy of morphine for the relief of breathlessness in patients with CHF. Method: Ten out-patients with NYHA IIIyIV CHF entered a randomised, double-blind, placebo controlled, crossover pilot study. The active arm was 4 days of 5 mg oral morphine four times daily (2.5 mg morphine if creatinine )200 mmolyl). There were 2 days wash-out between active and placebo arms. Results: 6y10 patients indicated that morphine improved their breathlessness. On morphine, the median breathlessness score fell by 23 mm (Ps0.022) by day 2. The improvement was maintained. Sedation scores increased until day 3 (Ps0.013), reducing on day 4. Four patients developed constipation (Ps 0.026). On placebo, there was no significant difference in breathlessness or sedation. One patient had constipation. There were no significant differences in either arm in nausea, quality of life scores, blood pressure, pulse, respiratory rate, or catecholamines. Brain natriuretic peptide fell in both arms; significantly in the morphine arm. Conclusion: Morphine relieves breathlessness due to CHF. A larger study is indicated.

Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study

“…[22,23] The sample deliberately did not engage people with acute exacerbations of breathlessness, although this would be an area for future research.…”

The Changing Landscape – Palliative Care in the Heart Failure Patient Population

“…Opioids have also been previously shown to be efficacious (Johnson et al 2002). However, a recent placebocontrolled study of two different oral opioids (morphine and oxycodone) in patients with CHF was not able to demonstrate any benefit (Oxberry et al 2011).…”

Harmful impact of morphine use in acute heart failure

“…However, so far, most of our experience with morphine use is based on symptoms in cancer patients, and our knowledge is limited pertaining to its use for symptoms in advanced heart failure in the setting of palliative care. Based on previous reports, opioids have shown inconsistent effects in patients with chronic heart failure (24,25). Double-blinded, placebocontrolled, cross-over pilot studies have demonstrated that oral morphine produced clinically significant improvement in breathlessness in ten patients with advanced heart failure, with few adverse effects and good tolerability of chronic dosing with low doses of morphine (24).…”

“…Based on previous reports, opioids have shown inconsistent effects in patients with chronic heart failure (24,25). Double-blinded, placebocontrolled, cross-over pilot studies have demonstrated that oral morphine produced clinically significant improvement in breathlessness in ten patients with advanced heart failure, with few adverse effects and good tolerability of chronic dosing with low doses of morphine (24). However, a recent randomized controlled double-blind cross-over trial demonstrated no benefit over a placebo for relief of breathlessness with short-term low-dose oral opioids for chronic heart failure patients (25).…”