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Management of Cancer Pain
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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To the Editor: Drs Bruera and Kim1 did not discuss the risk of opioid-induced respiratory depression, which is one of the primary fears that inhibit many physicians from adequately treating cancer pain with these medications. The perceived risk of initiating respiratory collapse and accelerating death with opioid medications is often overestimated and exaggerated among physicians.2
Respiratory depression does occur when an exogenous opioid is administered in animal and human models. Opioid-naive patients are far more susceptible to respiratory depression than patients who have received regularly scheduled opioid therapy for 5 days or more.3 Moreover, tolerance develops rapidly with repeated drug administration.4
More important, somnolence always precedes respiratory depression.5 Adequate ongoing assessment of alertness and appropriate titration of opioids will prevent unintended adverse outcomes. The choice of medications and delivery options also can decrease the likelihood of respiratory depression; the use of short-acting opioids with predictable pharmacology, such as intravenous or . . . [Full Text of this Article]
Chris Flores, MD
floreschris@msn.com
San Joaquin General Hospital
French Camp, Calif
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