Myths, Facts About Opioid Infusion in Treating Patients at the End of Life

Background: Patients often experience untreated symptoms, such as pain and dyspnea, at the end of life. Physicians often do not receive training on treating symptoms in dying patients, so practice patterns vary widely. This article focuses on current practice for the patient facing end-of-life pain and dyspnea management. Objective: To review the use of opioid bolus versus continuous infusion as initial therapy for pain control in the dying patient. Discussion: Opioid infusions seem to be an effective way to provide continuous comfort to dying patients and reduce the frequency of nurse visits for dosing. However, “titrate to comfort” can be challenging without additional bolus dosing, leading to rapid titration and increased side effects. Continuous opioids take hours to reach a steady state, so initial bolus doses are essential. If a patient needs >5 boluses in 4 hours, a continuous infusion may be considered, with boluses kept for acute discomfort. Bolus doses should be adjusted more...