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Morphine side effects can indicate infection

Research findings by the Palliative Care Team at Galway University Hospitals will be presented at a major conference this week, reports Dara Gantly

New morphine side effects in otherwise stable patients can warn palliative care physicians that infection is imminent even before a person’s temperature rises, research by the Palliative Care Team at Galway University Hospitals (GUH) has revealed.

According to Dr Dympna Waldron, Consultant in Palliative Medicine at GUH, this finding can help the medical team ensure that a person is treated for infection earlier and more effectively.

“Also we have found that in men the need for ongoing morphine can lower testosterone levels, which then can actually cause a lot of the symptoms of advanced cancer such as fatigue, low morale and poor muscle energy.

“When this occurs, the replacement of testosterone could eliminate all these symptoms,” explained Dr Waldron, ahead of a major conference on palliative medicine this week in Galway.

The second International Palliative Medicine Conference, organised by GUH, takes place on November 6 and 7 at the Radisson Hotel. A number of the world’s leading experts in the field will join their Irish colleagues in exploring a philosophy of palliative medicine that aims to help patients live both pain- and symptom-free, with good subjective quality of life — thus empowering them to live as whole and independent a life as possible.

Difficult to control
The meeting will showcase several important research findings by the team at GUH, including results on the drug pregabalin that prove it can ease and clear nerve and bone pain, which were previously notoriously difficult to control.

Research on the use of techniques such as hydrotherapy and touch therapies to help improve generalised pain, increase morale, ease fatigue and help a person be in ‘a better place’ will also be presented.

“With advances in research, pain control is now possible with minimum compromise,” explained conference organiser Dr Waldron.

“New drugs and interventions are available to allow morphine use target morphine-sensitive pain, and with attention to detail and good follow-up, we have found that morphine can be given in a way that it targets pain and does not float around in the body causing intolerable side effects.”

She explained that as disease reduces, with other treatments targeted at the source of pain like surgery, chemotherapy, radiotherapy and nerve blocks, morphine can be reduced and often stopped, to be recommenced appropriately as disease progresses.
“This way a person with advanced cancer and other difficult non-curative non-malignant illnesses can be pain-free for the majority of their illness without compromise,” she added.

A number of the world’s leading experts will be speaking at the two-day event, including clinician and researcher Dr Declan Walsh, Professor and Director of the Harry R. Horvitz Centre for Palliative Medicine, Cleveland Clinic, Ohio; Dr Michael Kearney, Medical Director of the Palliative Care Service at Santa Barbara Cottage Hospital, Santa Barbara; and Mr Gavin Quigley, Consultant Neurosurgeon, Royal Victoria Hospital, Belfast.

Outlining the importance of hosting such a conference in Galway, Dr Waldron said: “The Palliative Care Services in Galway University Hospitals, Roscommon County Hospital and Roscommon Home Care Team continue to progress, educate, develop and research new ideas to achieve better outcomes for our patient population.

“The person with complex illness and their families are at the centre of all our research aims. Enveloping change can be challenging, but very rewarding and we welcome all positive change,” she added.

The format of the conference includes presentations, round-table discussions and interactive patient videos — all based around seven ‘learning from’ themes. The above review of recent research carried out at GUH will form part of the ‘learning from research’ section, together with a presentation by Dr Declan Walsh: ‘An overview of relevant palliative medicine research findings over the last decade in the Cleveland Clinic, Ohio, USA’.

‘Learning from learning’ will be addressed with a presentation, ‘Forging an innovative undergraduate medical curriculum – an update on the Galway experience’, from Dr Gerard Flaherty, Lecturer in Medical Education & Clinical Skills, NUI Galway; while the theme of ‘learning to cope’ will be taken up by presentations on ‘The unconscious at work in the palliative care setting’ by Dr Evelyn McCabe, Consultant Psychiatrist, and ‘Complicated grief – recent developments in our understanding of grief’ by Dr Helen Greally, Director of Psychology and Support Services, Cancer Care West.

Learning to change
In his presentation on ‘Patient selection for brain stimulation’, Mr Gavin Quigley of the Royal Victoria Hospital, Belfast will deal with the theme of ‘learning to change’, while the concept of ‘learning from others’ will be tackled by presentations on ‘Plastic surgery and palliation – an oxymoron?’ by Mr Alan Hussey, Consultant Plastic Surgeon, GUH, and ‘What is video assisted thoracoscopic surgery (VATS)?’ by Mr Dave Veerasingam, Consultant Cardiothoracic Surgeon, GUH.

A panel discussion representing views of GPs and consultants in palliative medicine, geriatrics, oncology, intensive care and neurology will focus on the complex decision making process required to anchor a diagnosis on dying.

Further presentations on ‘Self-care of caregivers working at the end-of-life’ by Dr Michael Kearney, Medical Director of the Palliative Care Service at Santa Barbara Cottage Hospital, and on ‘Care of the team’ by Ursula Bates, Principal Clinical Psychologist, Blackrock Hospice, Dublin, will address the final theme of ‘learning to care for the carers’.

Posted in Guests on 06 November 2009
Tags: palliative care