Opioid Use in Palliative Care

Pain Management Challenges

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

Research on Non-Opioid Alternatives

A recent study led by Schüchen and colleagues explored the effectiveness of non-opioid painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs), in treating pain among palliative care patients. The findings were published in the Journal of Cachexia, Sarcopenia and Muscle.

Study Limitations

The meta-analysis focused exclusively on cancer patients, who represent only a third of those in palliative care. Other patient populations, including those with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes, also experience significant pain. This limitation stemmed from the historical belief that pain had a negligible impact on mortality for patients without malignant conditions. It is generally understood that increased pain intensity and frequency correlates with a diminished quality of life.

Findings on Non-Opioid Pain Relief

The study assessed various non-opioid medications, including NSAIDs, acetaminophen, flupirtine, and dipyrone. Out of 43 studies that met the inclusion criteria, results indicated that acetaminophen, whether used alone or in combination with strong opioids, did not provide significant pain relief. Conversely, moderate pain relief was observed with the use of NSAIDs, flupirtine, and dipyrone, although no single non-opioid medication demonstrated superior efficacy over the others.

Moreover, NSAIDs were found to achieve a similar level of pain reduction as approximately 15 mg of morphine or other comparable opioids. Both NSAIDs and strong opioids proved beneficial without generating tolerance issues. Ultimately, the study concluded that NSAIDs are highly effective in providing pain relief for cancer patients in palliative care.

Conclusion

The research emphasizes the potential of non-opioid analgesics, particularly NSAIDs, in managing pain for patients in palliative care settings.

References

Schüchen, R. H., Mü ke, M., Marinova, M., Kravchenko, D., Häus er, 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.

Written by Unaisa Bhayat, BMedSc.