2017 Volume 20 Issue 2 Pages 88-96
Purpose: Morphine has been recommended for the palliation of dyspnea in patients with amyotrophic lateral sclerosis (ALS); however, there is little evidence for its effectiveness or safety. The purpose of this study was to evaluate the usefulness of morphine for dyspnea management in patients with ALS.
Methods: We retrospectively reviewed the medical records of 10 consecutive patients with ALS who were administered morphine to relieve dyspnea. Morphine was used with advice and support from the multidisciplinary palliative care team in collaboration with physicians and nurses of our neurology ward. Palliation of dyspnea was defined as ≥1 increase in the dyspnea subscale of the ALS Functional Rating Scale-Revised (ALSFRS-R).
Results: The median morphine doses on the first day of administration were 10 mg/day (6–20 mg/day) enterally and 4.8 mg/day (2.4–12 mg/day) by continuous subcutaneous infusion. Dyspnea was palliated in 9 patients (90%). Patients with higher Palliative Performance Scale (PPS) scores at the time of morphine introduction tended to have improved ALSFRS-R dyspnea subscale scores (Spearman’s rho 0.77, p = 0.009). Beneficial changes were observed in the following living activities: alleviation of insomnia (n = 6) and increased food intake (n = 3). The median maximum daily doses of morphine were 21.5 mg/day (8–35 mg/day) enterally and 4.75 mg/day (2.4–24 mg/day) by continuous subcutaneous infusion. The median survival after morphine administration was 21 days (3–96 days), which was significantly correlated with PPS at the time of morphine introduction (Spearman’s rho 0.79, p = 0.006). Regarding adverse effects, all patients developed constipation, and three developed delirium. Eight patients died without the need for sedation, while two required sedation with midazolam.
Conclusion: Morphine is useful for dyspnea management in patients with ALS. Further studies are required to clarify the optimal timing for morphine introduction and the safe dosage.
