Subcutaneous Morphine for Dyspnea in Cancer Patients
Authors: Eduardo Bruera, Tara MacEachern, Carla Ripamonti, John Hanson
Journal: Annals of Internal Medicine (1993)

Brief Reports1 November 1993Subcutaneous Morphine for Dyspnea in Cancer PatientsEduardo Bruera, MD, Tara MacEachern, RN, BScN, Carla Ripamonti, MD, and John Hanson, MScEduardo Bruera, MDFrom Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy., Tara MacEachern, RN, BScNFrom Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy., Carla Ripamonti, MDFrom Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy., and John Hanson, MScFrom Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-9-199311010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Dyspnea has been defined as an uncomfortable awareness of breathing [1]. It occurs in approximately 29% to 74% of patients with terminal cancer [2, 3] and is perceived as one of the most devastating symptoms by the patient and the family. Controlled single-dose trials have suggested that opioids are effective in the management of dyspnea associated with chronic obstructive lung disease [4]. However, opioids were poorly tolerated in these patients during repeated administration, mostly because of sedation and nausea [5]. These side effects usually disappear with the development of tolerance and are rarely a cause for discontinuing treatment among the ...References1. Wasserman K, Casaburi R. Dyspnea: physiological and pathophysiological mechanisms. Annu Rev Med. 1988; 39:503-15. Google Scholar2. Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest. 1986; 89:234-6. Google Scholar3. Billings JA. Dyspnea, cough and other respiratory symptoms. In: Billings JA, ed. Outpatient Management of Advanced Cancer. Philadelphia: J.B. Lippincott; 1985:83. Google Scholar4. Woodcock AA, Gross ER, Gellert A, Shah S, Johnson M, Geddes DM. Effects of dihydrocodeine, alcohol, and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N Engl J Med. 1981; 305:1611-6. Google Scholar5. Woodcock A, Gross E, Gellery A. A comparison of diazepam and promethazine in the treatment of breathlessness in patients with chronic obstructive lung disease. Br Med J. 1982; 1:96. Google Scholar6. Foley KM. The treatment of cancer pain. N Engl J Med. 1985; 313: 84-95. Google Scholar7. Bruera E, Macmillan K, Pither J, MacDonald RN. Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage. 1990; 5:341-4. Google Scholar8. Folstein MF, Fetting JH, Lobo A, Niaz U, Capozzoli KD. Cognitive assessment of cancer patients. Cancer. 1984; 53(10 Suppl):2250-7. Google Scholar Author, Article, and Disclosure InformationAuthors: Eduardo Bruera, MD; Tara MacEachern, RN, BScN; Carla Ripamonti, MD; John Hanson, MScAffiliations: From Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy.Corresponding Author: Eduardo Bruera, MD, Edmonton General Hospital, Palliative Care Program, Room 9Y39, 11111 Jasper Avenue, Edmonton, Alberta, T5K 0L4, Canada. 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