The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea
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Date
2013-07-22
Authors
Currow, David Christopher
Quinn, Stephen
Greene, Aine
Bull, Janet
Johnson, Miriam J
Abernethy, Amy Pickar
Journal Title
Journal ISSN
Volume Title
Publisher
Mary Ann Liebert, Inc.
Rights
Rights Holder
© Mary Ann Liebert, Inc.
Abstract
Background: While evidence supports using sustained release morphine for chronic refractory breathlessness,
little is known about the longitudinal pattern of breathlessness intensity as people achieve symptomatic benefit.
The aim of this study is to describe this pattern.
Methods: This secondary analysis used breathlessness intensity scores (100mm visual analogue scale (VAS))
from a prospective, dose increment study of once daily (morning) sustained release morphine for chronic
refractory breathlessness. Participants who achieved < 10% improvement over their own baseline at one week
(10 mg) were titrated to 20mg and if no response, another week later to 30mg for one week. Time was standardized
at the first day of the week in which participants responded generating twice daily data one week
either side of symptomatic benefit. Analysis used random effect mixed modeling.
Results: Of the 83 participants, 17/52 responders required > 10 mg: 13 participants (20 mg) and 4 (30 mg),
contributing 634 VAS observations. In the week leading to a response, average VAS scores worsened by 0.3mm/
day ( p = 0.16); the average improvement in the first 24 hours of response was 10.9mm (7.0 to 14.7; p < 0.0001),
with continued improvement of 2.2 mm/day ( p < 0.001) for six more days.
Conclusion: When treating chronic refractory breathlessness with once daily sustained release morphine, titrate to
effect, since inadequate dose may generate no response; and following an initial response, further dose increases
should not occur for at least one week. Whether further benefit would be derived beyond day six on the dose to
which people respond, and what net effect a further dose increase would have are questions yet to be answered.
Description
Keywords
Palliative care, Clinical Pharmacology
Citation
Currow, D.C., Quinn, S., Greene, A., Bull, J., Johnson, M.J. and Abernethy, A.P., 2013. The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea. Journal of Palliative Medicine, 16(8), 881-886.