Opioid Use in Palliative Care

The Need for Pain Management

Many adults receiving palliative care are prescribed opioids to alleviate severe pain. According to the World Health Organization (WHO), approximately 19 million adults require palliative care towards the end of their lives, primarily due to pain. Opioids, such as morphine, are commonly used to manage this pain. However, the use of opioids is often accompanied by stigma and concerns regarding potential addiction.

Investigation of Non-Opioid Painkillers

A recent study led by Schüchen and colleagues aimed to assess the effectiveness of non-opioid painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs), in palliative care patients. This meta-analysis examined various factors including pain intensity, safety, quality of life, and avoidable side effects typically associated with opioid use. The findings were published in the Journal of Cachexia, Sarcopenia and Muscle.

Study Limitations and Patient Demographics

The study focused specifically on cancer patients, who represent only a third of the total population in palliative care. Patients with other conditions like cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes also experience significant pain. Historically, it was believed that pain played a minimal role in the mortality of patients without malignant diseases. The research highlighted that greater pain intensity and frequency correlate with a lower quality of life.

Findings on Non-Opioid Analgesics

The analysis included various non-opioid medications, such as NSAIDs, acetaminophen, flupirtine, and dipyrone. Out of 43 studies that met the criteria for inclusion, the results indicated that acetaminophen, both alone and in combination with strong opioids, did not provide significant pain relief. In contrast, NSAIDs, flupirtine, and dipyrone offered moderate pain relief, although no single non-opioid painkiller emerged as superior to the others.

The study revealed that NSAIDs could achieve a comparable pain reduction to approximately 15 mg of morphine or similar opioids, without leading to decreased tolerance. Conversely, acetaminophen was determined to be ineffective for pain relief in palliative care settings.

Conclusion

In conclusion, the study reinforced the utility of NSAIDs for managing pain in cancer patients receiving palliative care. The findings suggest that these non-opioid options can be beneficial alternatives to traditional opioid treatments.

Author Information

Written by Unaisa Bhayat, BMedSc

Reference

Schüchen, R. H., Müke, M., Marinova, M., Kravchenko, D., Häusser, W., Radbruch, L., Conrad, R. Systematic review and meta-analysis on non-opioid analgesics in palliative medicine. Journal of Cachexia, Sarcopenia and Muscle. 24 Aug 2018. DOI: 10.1002/jcsm.12352