Rapid intravenous opioid titration for acute symptom crises in palliative care: a real-world retrospective study

Rapid intravenous opioid titration is commonly used to manage acute symptom crises in palliative care, yet data describing its implementation and outcomes in routine practice remain limited.

To evaluate short-term symptom outcomes, immediate tolerability, and patient-reported satisfaction associated with rapid intravenous opioid titration in palliative care patients experiencing acute pain or dyspnea crises.

We conducted a retrospective single-center study including 38 hospitalized palliative care patients who underwent rapid intravenous opioid titration. The primary endpoint was symptom change between titration initiation and completion. Secondary outcomes included titration characteristics, patient-reported satisfaction with symptom management, and adverse events.

All patients had cancer, and 33 patients (87%) were receiving baseline opioid therapy. Titration was performed mainly for pain (89%, n = 34). Median pain intensity decreased from 8 to 2 on the NRS (p < 0.001), corresponding to a median reduction of 5 points. Overall, 34 patients (90%) were classified as responders. Dyspnea improved in all 4 treated patients. Clinically relevant adverse events occurred in 4 patients (11%). At 24 h, 29 patients (76%) reported complete satisfaction with symptom management. Greater symptom reduction was associated with higher patient-reported satisfaction, whereas clinically relevant adverse events were associated with lower satisfaction.

In this real-world cohort of specialist palliative care patients, rapid intravenous opioid titration was associated with substantial symptom improvement, high patient satisfaction, and a low rate of clinically relevant adverse events during titration and the subsequent 20-min observation period. These findings support the feasibility and immediate tolerability of this approach but do not establish longer-term safety.