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Morphine: a comfort measure for the dying or pain control for the living?
Date:12/10/2007

but inter-related categories: anticipation of death, morphine as a last resort, the role of the professional, and no choice but to commence.

Morphine as a last resort was the central theme to emerge from the interviews. The authors write: We found that patients with cancer who were offered morphine for pain relief interpreted this as a signal that their health professional thought they were dying, because opioids were interventions used only as a last resort. Because participants themselves were not ready to die, they rejected morphine and other opioids as analgesics, despite the pain experienced as a consequence. Participants descriptions of the role of professionals indicated that patients value professionals confidence in opioids. Some patients may therefore become more frightened when offered a choice, since this indicates a lack of confidence in the opioid as an analgesic.

It could be argued that the patients belief that the use of morphine represented a ramping up of treatment in the face of approaching death and the associated pain is a reasonably held view, especially as most of the patients interviewed for the study have subsequently died.

However, Dr Reid said: The World Health Organization guidelines for the management of cancer pain state that analgesic treatment choices should be based on the severity of the pain, not on prognosis. So patients at all stages of cancer could have morphine if their pain is sufficient. In reality, the patients most likely to experience pain, and likely also to have the most severe pain, are those with metastatic disease, i.e. their cancer cannot be cured. These patients may yet have many months to live, but their quality of life is adversely affected by pain, since unrelieved pain leads to social isolation, loss of role and depressed mood. This was the group of patients that we interviewed patients with metastatic disease and life expectancy measured in months.

The fear of these patien
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Contact: Emma Mason
wordmason@mac.com
44-077-112-96986
European Society for Medical Oncology
Source:Eurekalert

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