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Mazzocato, C., Buclin, T., & Rapin, C.H. (1999). The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: A randomized double-blind controlled trial. Annals of Oncology, 10(12), 1511–1514.
Subcutaneous (SC) morphine 5 mg or placebo in opioid-naïve patients and regular oral morphine dose plus half of the every-four-hour (q4h) dose given SC in patients on regularly scheduled opioids
Sample Characteristics
The sample was comprised of nine patients (seven opioid naïve and two opioid tolerant).
Mean patient age was 73 years.
The sample included four women with advanced cancer and dyspnea resulting from lung involvement.
All patients had normal Mini-Mental Status Examinations (MMSEs).
Setting
The study was conducted in an inpatient geriatric hospital.
Study Design
The study was a double-blind, placebo controlled, randomized, cross-over trial.
Measurement Instruments/Methods
Dyspnea visual analogue scale (VAS) (100 mm) and Borg scale obtained at baseline and 45 minutes after SC study dose and repeated until 240 minutes
VAS for pain, somnolence, and anxiety
Respiratory effort, including rate, cyanosis, and use of accessory muscles
Pulse oximetry
Results
Mean change of VAS (–25, p < 0.01) and Borg scale (–1.20, p = 0.03) scores were significantly decreased with morphine compared to placebo.
Respiratory effort (p = 0.05) and rate (p = 0.02) scores were significantly improved after morphine compared to placebo.
No significant changes in pain, somnolence, anxiety, or oxygen percent saturation were found.
Conclusions
Intermittent injections of morphine at the doses used reduce cancer-related dyspnea. The changes in respiratory effort and rate but not anxiety support the theory that the benefit of morphine is unlikely related to somnolence or an effect on anxiety.
Limitations
This is a well-designed randomized, controlled study with the major limitation of sample size.
The study points out the difficulty in conducting pharmacologic studies in patients with cancer and dyspnea.