Is morphine “comfort for dying” or pain control?

Cancer patients are suffering unnecessarily because they wronglybelieve that morphine and other opioids are only used as “comfort forthe dying” and as a “last resort” rather than seeing them as legitimatepain killers that can improve their quality of life.  In astudy published online today (Tuesday 11 December) in the cancerjournal, Annals of Oncology [1], experts in palliative care also say“the belief that opioids hasten death is widely held” amongst patientsand this “has a significant impact on pain management, as patients feltthat an offer of opioids signified imminent death”. Previous studieshave estimated that between 40-70% of cancer patients may not havetheir pain properly controlled with the right medication for a varietyof reasons.

Dr Colette Reid, the lead author of the study,said: “If we are to employ the range of available opioids in order tosuccessfully manage pain caused by cancer, we must ensure that morphinedoes not remain inextricably linked with death. If this connectionstays in place then morphine will continue to be viewed as a comfortmeasure for the dying rather than a means of pain control for theliving.”

Dr Reid, a consultant in palliative medicine at theGloucester Royal Hospital, Gloucester, UK, conducted in-depthinterviews with 18 patients with metastatic cancer, aged between 55 and82, who were asked to take part in a cancer pain management trial. Shewanted to examine how patients reacted when first offered an opioiddrug described as similar to morphine. Dr Reid also wanted tounderstand the factors that influenced patients’ decisions whether toaccept or to reject morphine. The interviews were analysed along withan experienced social scientist Rachael Gooberman-Hill, and GeoffreyHanks, professor of palliative medicine, both from the University ofBristol.

The patients interviewed were all white and half ofthem were women. Their views and experiences about morphine fell intofour distinct but inter-related categories: anticipation of death,morphine as a last resort, the role of the professional, and no choicebut to commence.

Morphine as a “last resort” was the centraltheme to emerge from the interviews. The authors write: “We found thatpatients with cancer who were offered morphine for pain reliefinterpreted this as a signal that their health professional thoughtthey were dying, because opioids were interventions used only as a‘last resort’. Because participants themselves were not ready to die,they rejected morphine and other opioids as analgesics, despite thepain experienced as a consequence. Participants’ descriptions of therole of professionals indicated that patients value professionals’confidence in opioids. Some patients may therefore become morefrightened when offered a choice, since this indicates a lack ofconfidence in the opioid as an analgesic.”

Source/more:  EurekAlert, http://www.eurekalert.org/pub_releases/2007-12/esfm-mac121007.php
Full journal article:  http://annonc.oxfordjournals.org/cgi/reprint/mdm462v1?gca=mdm462v1&sendit=Get+All+Checked+Abstract%28s%29&