However, respiratory depression caused by strong morphine-like pain medications is unlikely, if the initial dose of pain medication is appropriate, the dosage is increased one step at a time if needed, and the medication is administered monitoring the patient’s pain response. The pain itself creates an ongoing state of stress in the body, stimulating the activity of the respiratory centre and thus preventing the effects of the medication that would promote respiratory depression. At the end of life, breathing is affected by changes related to the approaching death regardless of pain medication. If left untreated, severe pain places the entire body under stress in a comprehensive manner, straining the heart and possibly limiting the patient’s breathing. In such cases, strong pain medications provide pain relief and therefore help the body work better – among other ways, by making it easier to breathe. Opioids are even used as symptom relief for shortness of breath.
Strong pain medications may interfere with the activities of the respiratory centre and cause respiratory depression in situations such as when the medication has been used inappropriately due to substance abuse or in cases of medication error. Cases of overdose involve clinical manifestations that a doctor is able to detect when examining the patient. If there is reason to suspect that pain medications may be impairing the patient’s breathing or causing respiratory depression, the dose of pain medication is reduced, and if necessary, the effects of the medication can be reversed with an antidote. It’s worth keeping in mind that as death approaches, breathing becomes more laboured and the patient’s breathing rhythm changes; this is unrelated to pain medication.