Effect of intraoral and subcutaneous morphine on dyspnea at rest in terminal patients with primary lung cancer or lung metastases

Abstract

Background: Dyspnea is considered as one of the most frequent and distressing symptoms in patients with advanced cancer, and systemic administration of morphine has been reported to have beneficial effect on this complaint.

Aim and design: The effect of red morphine drops (RMD) given orally and kept in the mouth as long as possible before swallowing to alleviate dyspnea was compared to the effect of morphine given subcutaneously (SCM) in a double-blind, double-dummy trial.

Participants: Twenty consecutive terminally ill patients with primary lung cancer or lung metastases admitted to Sankt Lukas Hospice were included in the study. All patients had dyspnea at rest, and they received either 1/12 of their 24-hour morphine dose as RMD or 60 percent of this dose as SCM. Perceived breathlessness was evaluated on a Visual Analogue Scale (VAS) during a 60 minutes observation time, and pulse rate, respiratory rate and oxygen saturation were assessed as well.

Results: Compared to baseline both RMD and SCM showed a small, but statistical significant effect on VAS (mean decrease of 1.1 [RMD] and 1.7 [SCM]) and pulse rate (mean decrease of 4 per minute [RMD] and 6 per minute [SCM]), the effect being significantly larger after SCM.

Conclusions: The study confirms the beneficial effect of morphine on dyspnea in terminally ill patients, and we conclude that RMD is an attractive alternative to injected morphine, when self-administration is preferable.