Morphine in the management of dyspnoea in ALS. A pilot study

• Published in: European journal of neurology Vol. 15; no. 5; pp. 445 - 450
• Main Authors: Clemens, K. E., Klaschik, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2008
• Subjects: Aged; amyotrophic lateral sclerosis; Amyotrophic Lateral Sclerosis - complications; Amyotrophic Lateral Sclerosis - drug therapy; Analgesia, Patient-Controlled - methods; Blood Gas Monitoring, Transcutaneous - methods; carbon dioxide partial pressure; Dyspnea - drug therapy; Dyspnea - etiology; dyspnoea; Female; Humans; Male; Middle Aged; morphine; Morphine - therapeutic use; Narcotics - therapeutic use; Oxygen Consumption - drug effects; Pilot Projects; Respiration - drug effects; respiratory depression; Respiratory Function Tests - methods
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2008.02102.x

Background and purpose:  The study aimed to verify the efficacy and safety of morphine in the management of dyspnoea in patients with terminal amyotrophic lateral sclerosis (ALS). A further aim was to assess the effect of morphine on ventilation and the potential diminishing effect of nasal O2‐insufflation preceding morphine administration on the intensity of dyspnoea. Methods:  Six dyspnoeic ALS patients were included in a prospective, non‐randomized study. The intensity of dyspnoea was measured with a Numeric Rating Scale (NRS 0–10). Transcutaneous carbon dioxide partial pressure (tcpaCO2), oxygen saturation (SaO2) and pulse frequency were continuously monitored during the nasal insufflation of O2 preceding the first morphine dose and also afterwards. Results:  A significant decrease was seen in both respiratory rate (from 42.0 ± 6.0/min to 29.0 ± 4.0) (P = 0.027) and the intensity of dyspnoea (from 7.5 ± 1.9 to 1.8 ± 0.8) (P = 0.027) 120 min after the morphine administration. Neither a significant tcpaCO2 increase nor a SaO2 decrease were seen. O2‐insufflation did not significantly decrease the intensity of dyspnoea. The anxiety of choking correlated highly significantly with the intensity of dyspnoea (r = 0.861, P = 0.028) in all patients. There were no cases of respiratory depression. Discussion:  Therapeutic doses of morphine were effective and safe in the management of dyspnoea in ALS patients.