Cited by 522Chronic Obstructive Pulmonary Disease (COPD) ResearchPain Management and Opioid UsePalliative Care and End-of-Life Issues

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Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea

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Abernethy, Amy P, Currow, David C, Frith, Peter, Fazekas, Belinda S, McHugh, Annie, Bui, Chuong·2003·BMJ

DOI 10.1136/bmj.327.7414.523PMC PMC192892

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Abstract

Objective To determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated. Design Randomised, double blind, placebo controlled crossover study. Setting Four outpatient clinics at a hospital in South Australia. Participants 48 participants who had not previously been treated with opioids (mean age 76, SD 5) with predominantly chronic obstructive pulmonary disease (42, 88%) were randomised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo, or vice versa. Laxatives were provided as needed. Main outcome measures Dyspnoea in the morning and evening as shown on a 100 mm visual analogue scale, quality of sleep, wellbeing, performance on physical exertion, and side effects as measured at the end of the four day treatment period. Results 38 participants completed the study; three withdrew because of definite and two because of possible side effects of morphine (nausea, vomiting, and sedation). Participants reported significantly different dyspnoea scores when treated with morphine: an improvement of 6.6 mm (95% confidence interval 1.6 mm to 11.6 mm) in the morning and of 9.5 mm (3.0 mm to 16.1 mm) in the evening (P = 0.011 and P = 0.006, respectively). During the period in which they were taking morphine participants also reported better sleep (P = 0.039). More participants reported distressing constipation while taking morphine (9 v 1, P = 0.021) in spite of using laxatives. All other side effects were not significantly worse with morphine, although the study was not powered to address side effects. Conclusions Sustained release, oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting.

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Authors: Abernethy, A. P., Currow, D. C., Frith, P., Fazekas, B. S., McHugh, A., & Bui, C.
Affiliations: Flinders University (AU)
Repatriation General Hospital (AU)
Nepean Hospital (AU)
Corresponding author: Currow, David C
ORCID: Abernethy, Amy P
Currow, David C
Frith, Peter
Venue: BMJ
Publisher: BMJ
Published: 2003-09-04
Volume: 327
Issue: 7414
Pages: 523-528
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.327.7414.523
PMC: PMC192892
OpenAlex: W2157851934
Cited by: 521
References: 26
Citations by year: 2026: 7 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 17 · 2021: 20 · 2020: 22 · 2019: 19 · 2018: 38 · 2017: 34 · 2016: 38 · 2015: 44 · 2014: 26 · 2013: 25 · 2012: 40
FWCI: 11.12
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations: BMJ (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Flinders Academic Commons (Flinders University) (submittedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: sustained-release morphine, oral morphine, chronic obstructive pulmonary disease, opioid therapy, dyspnea, sleep quality, constipation, opioid side effects, palliative care, community-based treatment
MeSH terms: Administration, Oral, Aged, Chronic Disease, Delayed-Action Preparations, Double-Blind Method, Dyspnea, Female, Humans, Male, Morphine, Narcotics, Cross-Over Studies, Pulmonary Disease, Chronic Obstructive

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Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea

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