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Supportive Care in Cancer

, Volume 11, Issue 12, pp 780–784 | Cite as

Oral morphine and respiratory function amongst hospice inpatients with advanced cancer

  • T. D. Walsh
  • N. I. Rivera
  • R. Kaiko
Original Article

Abstract

Background

Respiratory depression is the opioid adverse effect feared most by physicians. This may hinder adequate dosing in cancer pain. The study was conducted to examine the respiratory function of patients with advanced cancer receiving significant doses (>100 mg/24 h) of oral morphine.

Patients and methods

Consecutive pain-free hospice inpatients with advanced cancer receiving high-dose immediate-release oral morphine were evaluated. A single assessment of respiratory rate (RR), arterial blood gas (ABG), and peak flow rate (PFR) was made at assumed morphine steady state. Venous blood was drawn for a trough morphine plasma level.

Results

Of 31 patients who consented to examination, 20 completed the study assessment; 12 had chronic bronchitis. The median morphine dose was 30 mg 4-hourly (range 20 to 90 mg). Only one patient had evidence of ventilatory impairment.

Conclusions

Morphine does not commonly cause chronic ventilatory impairment when given in this way in this population even in the presence of pre-existing or concurrent respiratory disease. Oral morphine given repeatedly in individualized dosage is a safe and efficacious analgesic in the majority of those with advanced cancer.

Keywords

Cancer Hospice Morphine Pain Respiratory function 

Notes

Acknowledgements

The authors appreciate the assistance of Dr. P. Grabinski in the assay of plasma morphine, Dr. R. Baxter in performing the arterial blood gas analyses, Dr. M. Srivastava in reviewing the blood gas results, and Dr. C. Saunders for her advice and support.

References

  1. 1.
    Berry J (1994) Misconceptions about morphine use in cancer patients. Am Pharm NS34(4):34–36Google Scholar
  2. 2.
    Foley KM (1995) Misconceptions and controversies regarding the use of opioids in cancer pain. Anticancer Drugs 6 [Suppl 3]:4–13Google Scholar
  3. 3.
    Redmond K (1997) Organizational barriers in opioid use. Support Care Cancer 5:451–456CrossRefPubMedGoogle Scholar
  4. 4.
    Rigg JR (1978) Ventilatory effects and plasma concentration of morphine in man. Br J Anaesth 50:759–765PubMedGoogle Scholar
  5. 5.
    Eckenhoff JE, Oech SR (1960) The effect of narcotics and antagonists upon respiration and circulation in man. Clin Pharmacol Ther 1:483–524Google Scholar
  6. 6.
    Spector S (1971) Quantitative determination of morphine in serum by radioimmunoassay. J Pharmacol Exp Ther 178:253–258PubMedGoogle Scholar
  7. 7.
    Merskey H (1983) Diamorphine (heroin) and cancer pain. Can Med Assoc J 129:931–932PubMedGoogle Scholar
  8. 8.
    Twycross RG (1982) Morphine and diamorphine in the terminally ill patient. Acta Anaesthesiol Scand Suppl 74:128–134PubMedGoogle Scholar
  9. 9.
    Walsh TD, Saunders CM (1984) Heroin and morphine in advanced cancer. N Engl J Med 310:599Google Scholar
  10. 10.
    Walsh TD, Saunders CM (1981) Oral morphine for relief of chronic pain from cancer. N Engl J Med 305:1417–1418Google Scholar
  11. 11.
    Walsh TD (1984) Oral morphine in chronic cancer pain. Pain 18:1–11CrossRefPubMedGoogle Scholar
  12. 12.
    Walsh TD (1984) Opiates and respiratory function in advanced cancer. Recent Results Cancer Res 89:115–117PubMedGoogle Scholar
  13. 13.
    Budd RD, Leung WJ, Yang FC (1980) RIA opiates: structure versus reactivity. Clin Toxicol 17:383–393PubMedGoogle Scholar
  14. 14.
    Grabinski PY, Kaiko RF, Walsh TD, Foley KM, Houde RW (1983) Morphine radioimmunoassay specificity before and after extraction of plasma and cerebrospinal fluid. J Pharm Sci 72:27–30PubMedGoogle Scholar
  15. 15.
    Keats AS (1985) The effect of drugs on respiration in man. Annu Rev Pharmacol Toxicol 25:41–65CrossRefPubMedGoogle Scholar
  16. 16.
    Leino K, Mildh L, Lertola K, Seppala T, Kirvela O (1999) Time course of changes in breathing pattern in morphine- and oxycodone-induced respiratory depression. Anaesthesia 54:835–840CrossRefPubMedGoogle Scholar
  17. 17.
    Thompson PI, Joel SP, John L, Wedzicha JA, Maclean M, Slevin ML (1995) Respiratory depression following morphine and morphine-6-glucuronide in normal subjects. Br J Clin Pharmacol 40:145–152PubMedGoogle Scholar
  18. 18.
    Bulow HH, Linnemann M, Berg H, Lang-Jensen T, LaCour S, Jonsson T (1995) Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. Acta Anaesthesiol Scand 39:835–839PubMedGoogle Scholar
  19. 19.
    Borgbjerg FM, Nielsen K, Franks J (1996) Experimental pain stimulates respiration and attenuates morphine-induced respiratory depression: a controlled study in human volunteers. Pain 64:123–128CrossRefPubMedGoogle Scholar
  20. 20.
    Bruera E, Macmillan K, Pither J, MacDonald RN (1990) Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 5:341–344PubMedGoogle Scholar
  21. 21.
    Dudgeon DJ, Kristjanson L, Sloan JA, Lertzman M, Clement K (2001) Dyspnea in cancer patients: prevalence and associated factors. J Pain Symptom Manage 21:95–102CrossRefPubMedGoogle Scholar
  22. 22.
    Dudgeon DJ, Lertzman M (1998) Dyspnea in the advanced cancer patient. J Pain Symptom Manage 16:212–219CrossRefPubMedGoogle Scholar
  23. 23.
    Dudgeon DJ, Lertzman M, Askew GR (2001) Physiological changes and clinical correlations of dyspnea in cancer outpatients. J Pain Symptom Manage 21:373–379CrossRefPubMedGoogle Scholar
  24. 24.
    Campbell C, Weinger MB, Quinn M (1995) Alterations in diaphragm EMG activity during opiate-induced respiratory depression. Respir Physiol 100:107–117Google Scholar
  25. 25.
    Wanke T, Lahrmann H, Formanek D, Zwick B, Merkle M, Zwick H (1993) The effect of opioids on inspiratory muscle fatigue during inspiratory resistive loading. Clin Physiol 13:349–360PubMedGoogle Scholar
  26. 26.
    Quevedo F, Walsh D (1999) Morphine-induced ventilatory failure after spinal cord compression. J Pain Symptom Manage 18:140–142CrossRefPubMedGoogle Scholar
  27. 27.
    Donnelly S, Davis MP, Walsh D, Naughton M (2002) Morphine in cancer pain management: a practical guide. Support Care Cancer 10:13–35CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer CenterCleveland Clinic FoundationClevelandUSA
  2. 2.St. Christopher’s HospiceLondonUK
  3. 3.Memorial Sloan-Kettering Cancer CenterNew YorkUSA

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