Blinded Patient Preference for Morphine Compared to Placebo in the Setting of Chronic Refractory Breathlessness—An Exploratory Study

• Published in: Journal of pain and symptom management 2016-02, Vol.51 (2), p.247-254
• Main Authors: Ferreira, Diana H., MD, Silva, José P., MD, Quinn, Stephen, PhD, Abernethy, Amy P., MD, Johnson, Miriam J., MD, Oxberry, Stephen G., PhD, Currow, David C., PhD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anesthesia & Perioperative Care; breathlessness; COPD; Cross-Over Studies; Double-Blind Method; Dyspnea - drug therapy; Dyspnea - etiology; Dyspnea - physiopathology; Dyspnea - psychology; Female; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Failure - psychology; Humans; Male; morphine; Morphine - adverse effects; Morphine - therapeutic use; Multivariate Analysis; Nausea - complications; Nausea - physiopathology; Nausea - psychology; Pain Medicine; palliative care; Palliative Care - methods; Palliative Care - psychology; Palliative Care - statistics & numerical data; Patient preference; Patient Preference - psychology; Patient Preference - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; randomized controlled trial; Sex Factors; Treatment Outcome
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2015.10.005

Abstract Context Patients' preference for morphine therapy has received little attention in the setting of chronic refractory breathlessness. However, this is one important factor in considering longer term therapy. Objectives The aim of this secondary analysis was to explore blinded patient preference of morphine compared to placebo for this indication and to define any predictors of preference. Methods Data were pooled from three randomized, double-blind, crossover, placebo-controlled studies of morphine (four days each) in chronic refractory breathlessness. Blinded patient preferences were chosen at the end of each study. A multivariable regression model was used to establish patient predictors of preference. Results Sixty-five participants provided sufficient data (60 men; median age 74 years; heart failure 55%, chronic obstructive pulmonary disease 45%; median Eastern Cooperative Oncology Group performance status 2). Forty-three percent of participants preferred morphine (32% placebo and 25% no preference). Morphine preference and younger age were strongly associated: odds ratio = 0.85, 95% confidence interval 0.78–0.93; P