Can we predict which patients with refractory dyspnea will respond to opioids?

J Palliat Med. 2007 Oct;10(5):1031-6. doi: 10.1089/jpm.2007.9912.


Introduction: Dyspnea is frequently encountered in end-stage diseases even when reversible issues are addressed. Which clinical factors best define patient subpopulations that will most predictably benefit from opioids in this clinical setting?

Methods: Thirty-eight patients with refractory dyspnea were randomized to an 8-day crossover trial of 4 days of 20 mg sustained release morphine or placebo, switching arms on day 5 (Clinical Trial Registry Number: ACTRN012607000075482). Dyspnea was measured on a 100-mm visual analogue scale (VAS). Day 4 and day 8 morning and evening VAS scores were the primary outcome. Correlation between baseline dyspnea and response to opioids was explored; potentially important clinical predictors tested with two-sided Student's t test.

Results: In this exploratory study, no relationship could be defined between baseline dyspnea and response to opioids (Spearman correlation 0.03, p = 0.88). The study was not powered to define other predictors, but younger age, better functional status, and significant cardiac findings on entry to the study deserve further prospective evaluation in a larger cohort.

Discussion: Phase 4 pharmaco-vigilance trials are needed in palliative care to define people who are most likely to experience a net benefit from treatment such as opioids for refractory dyspnea.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use*
  • Cross-Over Studies
  • Dyspnea / drug therapy*
  • Female
  • Health Status Indicators
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Pilot Projects
  • Prognosis
  • Surveys and Questionnaires
  • Treatment Failure*
  • Treatment Outcome*


  • Analgesics, Opioid