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Decreased opioid doses used on a palliative care unit
R L Fainsinger1, K Louie, M Belzile
1Palliative Care Program, Edmonton General Hospital, Alberta, Canada.
Journal of Palliative Care
|January 1, 1996
Summary
Palliative care opioid use changed, with more frequent switching and methadone, leading to lower daily opioid doses in the last week of life. This strategy reduced the need for high-dose opioids in patients.
Area of Science:
- Palliative Care Medicine
- Pain Management
- Pharmacology
Background:
- Previous data documented opioid utilization in the final week of life.
- A shift in opioid prescribing patterns was implemented to optimize pain management.
Purpose of the Study:
- To evaluate the impact of a revised opioid prescribing strategy on opioid dosage and utilization in palliative care patients.
- To compare opioid use patterns in the last week of life between 1990 and 1992.
Main Methods:
- Retrospective chart review of 100 consecutive palliative care patients from 1992.
- Comparison of 1992 data with original data from 1990.
- Analysis of opioid types used and daily opioid dosage in the last week of life.
Main Results:
- A statistically significant decrease in the daily opioid dose was observed in the last week of life in 1992 compared to 1990.
- A reduction in the variety of opioids prescribed was noted.
- The revised strategy appeared to decrease the number of patients requiring high-dose opioids.
Conclusions:
- Frequent opioid switching and the judicious use of methadone (especially in cases of poor response or rapid tolerance) are effective in reducing high-dose opioid requirements.
- The updated opioid management approach in palliative care has demonstrated improved outcomes in pain management.
- This strategy leverages incomplete cross-tolerance between opioids to enhance patient comfort and reduce opioid escalation.