Respiratory function during parenteral opioid titration for cancer pain

Estfan, Bassam; Mahmoud, Fade; Shaheen, Philip E.; Davis, Mellar P.; Lasheen, Wael; Rivera, Nilo; LeGrand, Susan B.; Lagman, Ruth; Walsh, Declan; Rybicki, Lisa

doi:10.1177/0269216307077328

Cited by 49 publications

(26 citation statements)

References 15 publications

(18 reference statements)

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“…Appropriately titrated, opioids are safe and do not cause clinically significant respiratory depression. 41 Allen et al 42 showed that an opioid in low doses (diamorphine 2.5 mg subcutaneously) was effective and well tolerated in elderly patients with advanced pulmonary fibrosis who had not received opioids before.…”

Section: Look For Potentially Reversible Causes Of Nausea and Vomitingmentioning

confidence: 99%

Symptom management: An important part of cancer care

Shoemaker

Estfan

Induru

et al. 2011

CCJM

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Section: Look For Potentially Reversible Causes Of Nausea and Vomitingmentioning

confidence: 99%

Symptom management: An important part of cancer care

Shoemaker

Estfan

Induru

et al. 2011

CCJM

Self Cite

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“…Indeed, a common misconception is that opioid use will hasten death through respiratory depression, 38 although there is little evidence to support this belief when the drugs are appropriately titrated. 11,39,40 Reid et al 37 found that some cancer patients perceived opioids as a "last resort" for pain control and thus interpreted their physicians' offer of morphine for pain relief as a signal that death was near, rejecting the opioid as a consequence.…”

Section: Discussionmentioning

confidence: 99%

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Fisher

Urquhart

Johnston

2013

Journal of Pain and Symptom Management

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Context-Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.Objectives-To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.Methods-Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.Results-In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93).Conclusion-PCPs may play an important role in enabling access to end-of-life care within the community.

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“…Eine Atemdepression bei Tumorschmerz kann durch Opioidtitration vermieden werden [26]. Die Individualisierung der Schmerztherapie ist die Grundlage für die Tumorschmerztherapie [27].…”

Section: Dosis -Titrationunclassified

Grenzen der Schmerztherapie

Zenz

Saan

2011

Schmerz

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Medical principles of pain treatment are generally in line with the judicial principles. To relieve pain is one of the fundamentals of medicine and this has also been acknowledged by the Federal Court in Germany. It is criminal bodily harm, when a physician denies a possible pain treatment. Whereas courts clearly see an obligation to basic and continuing education in pain diagnosis and therapy, pain is still not represented in the German licensing regulations for physicians. Only palliative medicine has been added to the obligatory curriculum. Very similar pain is not mandatory in many clinical disciplines leaving physicians without the needed knowledge to treat pain. The need for interdisciplinary treatment is not yet acknowledged sufficiently, although meanwhile chronic pain is regarded as a bio-psycho-social illness.Since 2009 the advance directive is regulated by law. However, still many physicians are unaware that not only the position of the patient but also of the relatives have been strengthened. In 2010 the Federal Court has pronounced a judgment allowing "passive euthanasia" in certain conditions but prohibiting any active handling even in line with the patient's will. This is also in line with the European Human Rights Convention. The judicial unpunished assisted suicide has provoked an ethical discussion within the medical profession. However, what is not illegal is not automatically accepted as ethical handling for physicians. Palliative medicine is at least one alternative in this discussion.

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Respiratory function during parenteral opioid titration for cancer pain

Abstract: Parenteral opioid titration for relief of cancer pain was not associated with respiratory depression as demonstrated by significant changes in ET-CO(2) or oxygen saturation in non-oxygen dependent cancer patients.

Cited by 49 publications

References 15 publications

Symptom management: An important part of cancer care

Symptom management: An important part of cancer care

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Grenzen der Schmerztherapie

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