Effect of intraoral and subcutaneous morphine on dyspnea at rest in terminal patients with primary lung cancer or lung metastases
Background: Dyspnea is considered as one of the most frequent and distressing symptoms in patients with advanced cancer, and systemic administration of morphine has been reported to have beneficial effect on this complaint. Aim and design: The effect of red morphine drops (RMD) given orally and kept in the mouth as long as possible before swallowing to alleviate dyspnea was compared to the effect of morphine given subcutaneously (SCM) in a double-blind, double-dummy trial. Participants: Twenty consecutive terminally ill patients with primary lung cancer or lung metastases admitted to Sankt Lukas Hospice were included in the study. All patients had dyspnea at rest, and they received either 1/12 of their 24-hour morphine dose as RMD or 60 percent of this dose as SCM. Perceived breathlessness was evaluated on a Visual Analogue Scale (VAS) during a 60 minutes observation time, and pulse rate, respiratory rate and oxygen saturation were assessed as well. Results: Compared to baseline both RMD and SCM showed a small, but statistical significant effect on VAS (mean decrease of 1.1 [RMD] and 1.7 [SCM]) and pulse rate (mean decrease of 4 per minute [RMD] and 6 per minute [SCM]), the effect being significantly larger after SCM. Conclusions: The study confirms the beneficial effect of morphine on dyspnea in terminally ill patients, and we conclude that RMD is an attractive alternative to injected morphine, when self-administration is preferable.
Available from: Richard J Bodnar
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ABSTRACT: This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
Available from: synapse.koreamed.org
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ABSTRACT: Pleural metastasis from breast cancer is a common manifestation. While pleural effusion is the most frequent finding, it is relatively rare for pleural nodularity and plaque that do not accompany pleural effusion. We report a patient with a rapidly growing huge pleural mass without pleural effusion caused by breast cancer. The patient was treated for severe dyspnea caused by the pleural mass. Along with the case report, we performed a systematic review of management of dyspnea in terminal cancer patients.
Available from: Wolfgang Hohenforst-Schmidt
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