Wednesday, October 5, 2005

Memory deficits with morphine

The current Pain has an curious article about the cognitive effects of morphine. It's a small study (n=14) of patients on chronic long acting opioids (average MEDD of 190mg) who require minimal breathrough. They are given their usual breakthrough dose (avg. 20mg) or placebo & a bunch of cognitive tests are run. The next day they get the other treatment and more tests are run. Interestingly the VAS pain scores weren't much different but those who received morphine reported substantially more pain "relief." There were no differences in sedation. Anyway, the patients experienced more anterograde and retrograde memory loss after the morphine dose than placebo; other than that other cognitive domains were intact. This study is clearly very small & limited & I don't think any clinical implications can be made; nevertheless it looks at a practice which is probably second nature to most of us (the use of breakthrough short acting opioids in patients on long acting opioids) & asks what are some of the drawbacks. The authors warn of quality of life problems based on their findings however they didn't measure quality of life & I wager there would be quality of life problems with not having as needed analgesia....

(There is also an interesting case report of a woman with congenital insensitivity to pain whose first painful experience was a tension headache after a traumatic emotional event.)

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