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Prolonged oral morphine therapy for severe angina pectoris
M Mouallem1, E Schwartz, Z Farfel
1Department of Medicine E, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
Journal of Pain and Symptom Management
|June 28, 2000
Summary
For patients with severe angina unresponsive to treatment, low-dose controlled-release oral morphine (CRM) significantly reduced hospital admissions and stays. This chronic opioid therapy offers an effective option with minimal side effects.
Area of Science:
- Cardiology
- Pain Management
- Pharmacology
Background:
- Intractable angina pectoris presents a significant challenge for patients unresponsive to standard treatments and ineligible for revascularization.
- Optimal drug therapy and revascularization procedures are not always suitable for all patients with refractory angina.
Observation:
- A study investigated the efficacy of chronic opioid therapy in four elderly patients (mean age 79.5 years) with intractable angina.
- Patients received low-dose (mean 40 mg/day) controlled-release oral morphine (CRM) for 1 to 5 years.
Findings:
- CRM therapy led to a substantial reduction in hospital admissions, from a mean of 6 to 1.5 per year.
- Hospitalization duration for angina decreased significantly from 42 ± 35 days to 6 ± 10 days (p < 0.05).
- Side effects were minimal, primarily consisting of constipation manageable with lactulose.
Implications:
- Prolonged low-dose controlled-release oral morphine therapy demonstrates efficacy and safety in selected patients with intractable angina.
- This approach may provide a valuable therapeutic option for refractory angina patients who cannot undergo revascularization.
- Further research into long-term opioid management for chronic pain conditions like angina is warranted.