title: Opioid risk assessment in palliative medicine.
abstract: BACKGROUND
  Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted.
  
  
  METHODS
  This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff.
  
  
  CONCLUSIONS
  Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.
authors.affiliation: University of Washington, Department of Psychiatry , Box 359896, 325 Ninth Ave, Seattle, WA 98104 , USA krashind@uw.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Krashin
authors.forename: Natalia
authors.initials: N
authors.lastname: Murinova
authors.forename: Patricia
authors.initials: P
authors.lastname: Jumelle
authors.forename: Jane
authors.initials: J
authors.lastname: Ballantyne
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000517:prevention & control; D006801:Humans; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D020379:Risk Adjustment; D018570:Risk Assessment
chemical_list: D000701:Analgesics, Opioid
keywords: addiction; cancer pain; constipation; hospice; injury; opioid use disorder; opioids; palliative care; sedation