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Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients

  • Chronic Pain Medicine (O Viswanath, Section Editor)
  • Published:
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Abstract

Purpose of Review

The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care.

Recent Findings

Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation.

Summary

Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.

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Data Availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Alan D. Kaye & Sahar Shekoohi

  2. Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA

    Alan D. Kaye

  3. School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA

    Kylie Dufrene, Jada Cooley, Madeline Walker, Shivam Shah & Alex Hollander

  4. Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Christopher L. Robinson

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Contributions

Study design: ADK, KD, JC, MW, SS, AH, SS and CLR. Drafting of the manuscript: ADK, KD, JC, MW, SS, AH, SS and CLR. Critical review: ADK, KD, JC, MW, SS, AH, SS and CLR. All authors reviewed the manuscript.

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Correspondence to Sahar Shekoohi.

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Alan D. Kaye is an editor-in-chief for Current Pain and Headache Reports.

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Kaye, A.D., Dufrene, K., Cooley, J. et al. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01248-0

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