Drugs used to alleviate symptoms with life shortening as a possible side effect: end-of-life care in six European countries

J Pain Symptom Manage. 2006 Feb;31(2):111-21. doi: 10.1016/j.jpainsymman.2005.07.005.


We investigated the drugs used in the alleviation of pain and symptoms (APS) with a possible life-shortening side effect in six European countries' end-of-life care. We sent mail questionnaires to physicians who signed a representative sample of death certificates in each country. APS with a possible life-shortening effect occurred from 19% of all deaths in Italy to 26% in Denmark. Physicians usually administered opioids (from 76% of APS cases in Italy to 96% in The Netherlands), but the type of opioids and administration practice differed markedly between countries. The doses of opioids given in the last 24 hours also varied significantly and were usually lower than 300 mg oral morphine equivalent (from 83% of cases in Belgium to 93% in Sweden). The highly variable results bring into question whether existing guidelines for pain relief were applied appropriately and to what extent unfounded concerns about the possible life-shortening effect of opioids resulted in less than optimal symptom management in end-of-life care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / therapeutic use
  • Death Certificates
  • Decision Making
  • Dose-Response Relationship, Drug
  • Drug Prescriptions / statistics & numerical data
  • Europe / epidemiology
  • Euthanasia, Active / statistics & numerical data*
  • Humans
  • Life Support Care / statistics & numerical data*
  • Male
  • Middle Aged
  • Narcotics / therapeutic use*
  • Pain / drug therapy*
  • Pain / mortality*
  • Palliative Care / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Suicide, Assisted / statistics & numerical data
  • Surveys and Questionnaires
  • Terminal Care / statistics & numerical data*


  • Analgesics
  • Narcotics