Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is very common in hospice settings. However, it is unknown how many of the patients require high dose morphine(HDM, >300mg/day of oral morphine equivalent), what the characteristics of these ...
Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is very common in hospice settings. However, it is unknown how many of the patients require high dose morphine(HDM, >300mg/day of oral morphine equivalent), what the characteristics of these patients are, and whether the pain is well controlled. Therefore, the actual method in clinical use of morphine was investigated by analyzing the morphine dosage, the adverse reactions from the use of morphine, pain severity and the characteristics of terminal cancer patients to suggest appropriate terminal care, especially during the last 3 days of life. This study was based on 72 terminal cancer patients who had been received the HDM and expired in the Kangnam St Mary’s Hospital from January 1999 through December 2000. Medical records were reviewed to obtain information on the demographic parameters, medical diagnosis(primary tumors & metastasis), pain severity, morphine dosage, use of coanalgesics, adverse effects and so on. Several statistical methods were used to characterize patient morphine use in the hospice settings.(particularly during the last 3 days of life.) with the following results; The number of patients investigated was 72, male, 33cases(45.8%) and the female 39cases(54.2%) and the adverse effects of morphine were constipation, nausea and vomiting, confusion, respiratory depression, and sedation, while there were not any drug tolerances or addictions. The range of mean daily morphine use was between 139.2mg and 4140.0mg oral morphine equivalent(OME). The mean daily morphine requirement was 559.9mg OME from the admission day to the end of life except last 3 days(OME1) and the median was 409.2mg OME. During the last 3 days of life, the mean daily morphine requirement was 687.7mg(OME2) and the median was 474.9 OME, showing a significant difference between OME1 and OME2(P<0.05). There was no statistically difference in OME2 and pain severity. However, a fairly strong correlation exists between OME1 and OME2 and approximately 70% of patients received inadequate pain management resulting in greater or less severity of pain. In addition, there were also no statistically significant dependences of OME2 on sex, metastasis, and the number of coanalgesics. No significant dose-limiting adverse effects were observed, thus it is not necessary to avoid to give HDM. Increasing the dose or changing the route of administration of morphine through periodic and regular reassessment of pain are important to improve the pain management and other skills to control pain properly are needed.
Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is very common in hospice settings. However, it is unknown how many of the patients require high dose morphine(HDM, >300mg/day of oral morphine equivalent), what the characteristics of these patients are, and whether the pain is well controlled. Therefore, the actual method in clinical use of morphine was investigated by analyzing the morphine dosage, the adverse reactions from the use of morphine, pain severity and the characteristics of terminal cancer patients to suggest appropriate terminal care, especially during the last 3 days of life. This study was based on 72 terminal cancer patients who had been received the HDM and expired in the Kangnam St Mary’s Hospital from January 1999 through December 2000. Medical records were reviewed to obtain information on the demographic parameters, medical diagnosis(primary tumors & metastasis), pain severity, morphine dosage, use of coanalgesics, adverse effects and so on. Several statistical methods were used to characterize patient morphine use in the hospice settings.(particularly during the last 3 days of life.) with the following results; The number of patients investigated was 72, male, 33cases(45.8%) and the female 39cases(54.2%) and the adverse effects of morphine were constipation, nausea and vomiting, confusion, respiratory depression, and sedation, while there were not any drug tolerances or addictions. The range of mean daily morphine use was between 139.2mg and 4140.0mg oral morphine equivalent(OME). The mean daily morphine requirement was 559.9mg OME from the admission day to the end of life except last 3 days(OME1) and the median was 409.2mg OME. During the last 3 days of life, the mean daily morphine requirement was 687.7mg(OME2) and the median was 474.9 OME, showing a significant difference between OME1 and OME2(P<0.05). There was no statistically difference in OME2 and pain severity. However, a fairly strong correlation exists between OME1 and OME2 and approximately 70% of patients received inadequate pain management resulting in greater or less severity of pain. In addition, there were also no statistically significant dependences of OME2 on sex, metastasis, and the number of coanalgesics. No significant dose-limiting adverse effects were observed, thus it is not necessary to avoid to give HDM. Increasing the dose or changing the route of administration of morphine through periodic and regular reassessment of pain are important to improve the pain management and other skills to control pain properly are needed.
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