Opioid in palliative care

Jump to: navigation, search

Opioid Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pharmacology

Indications

Opioid in benign chronic pain
Opioid in palliative care

Contraindications

Adverse Reactions

Abuse and Dependence

Overdose

Withdrawal

Shortage Status

Opioid in palliative care On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Opioid in palliative care

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Opioid in palliative care

CDC on Opioid in palliative care

Opioid in palliative care in the news

Blogs on Opioid in palliative care

Directions to Hospitals Treating Opioid

Risk calculators and risk factors for Opioid in palliative care

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Palliative Care

The current key text for palliative care is the Oxford Textbook of Palliative Medicine, 3rd ed. (Doyle, D., Hanks, G., Cherney, I., and Calman, K., eds., Oxford University Press, 2004). This states that the indications for opioid administration in palliative care are:

  • "Any pain of moderate or greater severity, irrespective of the underlying pathophysiological mechanism." (p.327)
  • Breathlessness / shortness of breath: the largest evidence base exists for morphine. Several mechanisms are suggested for its action on breathlessness (p.605–7).
  • Diarrhoea: codeine and loperamide are the most widely used opioid for this problem. Loperamide has the advantage of acting only on the gut, since very little is absorbed (p.493).
  • Painful wounds: topical morphine in an aqueous gel can be an effective agent (p.392). Their use is based on the discovery of activated opioid receptors in damaged tissue.

In palliative care opioids are always used in combination with adjuvant analgesics (drugs which have an indirect effect on the pain), and as an integral part of care of the whole person.

Contraindications for Opioids in Palliative Care

In palliative care, opioids are not recommended for sedation or anxiety because experience has found them to be ineffective agents in these roles. Some opioids are relatively contraindicated in renal failure because the of accumulation of the parent drug or their active metabolites (e.g. morphine and oxycodone). Age (young or old) is not a contraindication to strong opioids.

References



Linked-in.jpg