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High doses of opioids usage for amyotrophic lateral sclerosis patients with non-invasive ventilation

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Abstract

Introduction

While opioids have been found to be useful in relieving suffering in amyotrophic lateral sclerosis (ALS), there is a lack of evidence concerning how and how much to use them in practice. This study was conducted to clarify how opioids were used for patients with ALS.

Methods

We performed a retrospective case-based analysis at a single tertiary neurology center in Tokyo from 2010 to 2018. We enrolled patients with ALS who had died before the end of 2018. We examined the opioid dosage equivalent of morphine hydrochloride and patients’ clinical backgrounds, focusing on ventilatory support.

Results

Morphine was administered in 110 patients with ALS, and 84 were followed up until their death. Of these 84 patients, 57 (69.9%) did not use mechanical ventilation until death (no-MV group), and 21 (22.9%) utilized only non-invasive ventilation (NIV group). Final morphine dosage in the NIV group was significantly higher (mean 65.7 mg [SD 54.6], range 10–200 mg) than in the no-MV group (mean 31.7 mg [SD 26.9], range 0–120 mg; p = 0.015, Welch’s t-test). The NIV group needed psychotropic drugs more frequently than the no-MV group (62% [n = 13] vs. 35% [n = 20]).

Conclusion

Patients in the NIV group used opioids for a statistically significantly longer time and at a higher dose than those in the no-MV group. Symptom control with opioids alone may be difficult, and the development of multifaceted evaluation and care is desirable.

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Data availability

The anonymized datasets analyzed during the current study will be shared from the corresponding author on reasonable request.

References

  1. Oliver DJ (2019) Palliative care in motor neurone disease: where are we now? Palliat Care. https://doi.org/10.1177/1178224218813914

    Article  PubMed  PubMed Central  Google Scholar 

  2. Neudert C, Oliver D, Wasner M, Borasio GD (2001) The course of the terminal phase in patients with amyotrophic lateral sclerosis. J Neurol 248:612–616. https://doi.org/10.1007/s004150170140

    Article  CAS  PubMed  Google Scholar 

  3. O’brien T, Kelly M, Saunders C (1992) Motor neurone disease: a hospice perspective. BMJ 304:471–473. https://doi.org/10.1136/bmj.304.6825.471

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ (2006) Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol 5:140–147. https://doi.org/10.1016/s1474-4422(05)70326-4

    Article  PubMed  Google Scholar 

  5. Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W et al (2009) Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 73:1218–1226. https://doi.org/10.1212/wnl.0b013e3181bc0141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis:, Anderson PM, Abrahams S, Borasio GD, et al. (2012) EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS) -- revised report of an EFNS task force. Eur J Neurol 19:360–375. https://doi.org/10.1111/j.1468-1331.2011.03501.x

  7. Khamankar N, Coan G, Weaver B, Mitchell CS (2018) Associative increases in amyotrophic lateral sclerosis survival duration with non-invasive ventilation initiation and usage protocols. Front Neurol 9:578. https://doi.org/10.3389/fneur.2018.00578

    Article  PubMed  PubMed Central  Google Scholar 

  8. Oliver DJ (2016) Palliative care for patients with motor neurone disease: current challenges. Degener Neurol Neuromusc Dis 6:65–72. https://doi.org/10.2147/DNND.S85103

    Article  Google Scholar 

  9. Clemens KE, Klaschik E (2008) Morphine in the management of dyspnoea in ALS. A pilot study. Eur J Neurol 15:445–450. https://doi.org/10.1111/j.1468-1331.2008.02102.x

    Article  CAS  PubMed  Google Scholar 

  10. Miller RG, Rosenberg JA, Gelinas DF, Mitsumoto H, Newman D, Sufit R et al (1999) Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurology 52:1311–1323. https://doi.org/10.1212/wnl.52.7.1311

    Article  CAS  PubMed  Google Scholar 

  11. Oliver DJ, Campbell C, O’brien T, Sloan R, Sykes N, Tallon C, Taylor-Horan J, Udoma M (2010) Medication in the last days of life for motor neuron disease/amyotrophic lateral sclerosis. Amyotroph Lateral Scler 11:562–564. https://doi.org/10.3109/17482968.2010.493203

    Article  PubMed  Google Scholar 

  12. Oliver D (1998) Opioid medication in the palliative care of motor neurone disease. Palliat Med 12:113–115. https://doi.org/10.1191/026921698677326556

    Article  CAS  PubMed  Google Scholar 

  13. Vogt S, Schreiber S, Heinze HJ, Dengler R, Petri S, Vielhaber S (2019) The Dyspnea-ALS-Scale (DALS-15) optimizes individual treatment in patients with amyotrophic lateral sclerosis (ALS) suffering from dyspnea. Health Qual Life Outcomes 17:95. https://doi.org/10.1186/s12955-019-1167-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dreyer PS, Felding M, Klitnæs CS, Lorenzen CK (2012) Withdrawal of invasive home mechanical ventilation in patients with advanced amyotrophic lateral sclerosis: ten years of Danish experience. J Palliat Med 15:205–209. https://doi.org/10.1089/jpm.2011.0133

    Article  PubMed  Google Scholar 

  15. Takahashi K, Murakami F, Komai K, Ishida C, Kato-Motozaki Y (2021) Difference in the care of patients with amyotrophic lateral sclerosis with and without intervention from the palliative care team: observations from a center in Japan. Palliat Med Rep 2:201–206. https://doi.org/10.1089/pmr.2020.0084

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brooks BR, Miller RG, Swash M, Munsat TL, World Federation of Neurology Research Group on Motor Neuron Diseases (2000) El Escorial revised: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 1:293–299. https://doi.org/10.1080/146608200300079536

    Article  CAS  PubMed  Google Scholar 

  17. de Calvalho M, Dengler R, Eisen A, England JD, Kaji R, Kimura J et al (2008) Electrodiagnostic criteria for diagnosis of ALS. Clin Neurophysiol 119:497–503. https://doi.org/10.1016/j.clinph.2007.09.143

    Article  Google Scholar 

  18. Fallon M, Giusti R, Aielli A, Hoskin P, Rolke R, Sharma M, Ripamonti CI, ESMO Guidelines Committee (2018) Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 29:166–191. https://doi.org/10.1093/annonc/mdy152

    Article  Google Scholar 

  19. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A et al (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383:1721–1730. https://doi.org/10.1016/s0140-6736(13)62416-2

    Article  PubMed  Google Scholar 

  20. Ogino M (2010) Survey report on end-of-life care for ALS patients of ALS physicians in Japan [article in Japanese]. Rinsho Shinkeigaku 50:1026–1028. https://doi.org/10.5692/clinicalneurol.50.1026

    Article  PubMed  Google Scholar 

  21. Schuh LA, Blondo A, An A, Newman D, Ryczko S, Remer S, Bricker L (2007) Neurology resident learning in an end-of-life/palliative care course. J Palliat Med 10:178–181. https://doi.org/10.1089/jpm.2006.0089

    Article  PubMed  Google Scholar 

  22. Ganzini L, Johnston WS, Silveira MJ (2002) The final month of life in patients with ALS. Neurology 59:428–431. https://doi.org/10.1212/wnl.59.3.428

    Article  PubMed  Google Scholar 

  23. van Groenestijn AC, Kruitwagen-van Reenen ET, Visser-Meily JMA, ven den Berg LH, Schröder CD (2016) Associations between psychological factors and health-related quality of life and global quality of life in patients with ALS: a systematic review. Health Qual Life Outcomes 14:107. https://doi.org/10.1186/s12955-016-0507-6

  24. Edge R, Mills R, Tennant A, Diggle PJ, Young CA, the TONiC study group (2020) Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature. J Neurol 267:607–615. https://doi.org/10.1007/s00415-019-09615-3

    Article  PubMed  Google Scholar 

  25. Bond L, Bowen G, Mertens B, Denson K, Jordan K, Vidakovic B, Mitchell CS (2020) Associations of patient mood, modulators of quality of life, and pharmaceuticals with amyotrophic lateral sclerosis survival duration. Behav Sci 10:33. https://doi.org/10.3390/bs10010033

    Article  PubMed  PubMed Central  Google Scholar 

  26. Caga J, Hsieh S, Highton-Williamson E, Zonig MC, Ramsey E, Devenney E, Ahmed RM, Kiernan MC (2018) Apathy and its impact on patient outcome in amyotrophic lateral sclerosis. J Neurol 265:187–193. https://doi.org/10.1007/s00415-017-8688-4

    Article  CAS  PubMed  Google Scholar 

  27. Jackson CE, McVey AL, Rudnicki S, Dimachkie MM, Barohn RJ (2015) Symptom management and end-of-life care. Neurol Clin 33:889–908. https://doi.org/10.1016/j.ncl.2015.07.010

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by JSPS KAKENHI Grant Number JP22H03398. We thank the members of the palliative care team members (esp. Naoko Shimizu RN, Tamami Arai RN, Takashi Kobayashi Pharm.D, Mari Inoue CCP, Chiharu Matsuda RN, Ph.D., and the other Palliative-care-link-nurses), for their very thought-provoking advice and their incredible efforts in the daily care of our patients. We likewise thank Prof. Masanari Itokawa for his insightful advice on the manuscript and research.

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Authors and Affiliations

  1. Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan

    Ryo Morishima, Toshio Shimizu, Hideki Kimura, Kota Bokuda & Kazushi Takahashi

  2. Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan

    Ryo Morishima, Toshio Shimizu, Kota Bokuda & Yuki Nakayama

  3. Department of Rehabilitation Medicine, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan

    Takako Saotome

  4. Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan

    Ryo Morishima, Toshio Shimizu, Hideki Kimura, Kota Bokuda & Takako Saotome

Authors
  1. Ryo Morishima
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  2. Toshio Shimizu
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  3. Hideki Kimura
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ryo Morishima and Toshio Shimizu. The first draft of the manuscript was written by Ryo Morishima and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ryo Morishima.

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Morishima, R., Shimizu, T., Kimura, H. et al. High doses of opioids usage for amyotrophic lateral sclerosis patients with non-invasive ventilation. Acta Neurol Belg 124, 101–107 (2024). https://doi.org/10.1007/s13760-023-02344-5

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  • DOI: https://doi.org/10.1007/s13760-023-02344-5

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