The effectiveness of opioids in relieving intractable pain and respiratory discomfort has been established not only for patients with cancer, but also for those with progressive neurological disease, including ALS. Meanwhile, appropriate methods of opioid use have not been clarified in ALS.

We performed a retrospective case-based analysis to investigate how opioids were used in patients with ALS in our hospital between 2010 and 2018. We analyzed the data of patients with ALS who had deceased by the year 2018. We examined the dosage of opioids equivalent to that of morphine hydrochloride.

Morphine was administered in 110 patients with ALS, and 83 patients were followed up until death. Of these 83 patients, 58 patients (69.9%) did not receive mechanical ventilation (MV) before death. Nineteen patients (22.9%) received only noninvasive ventilation (NIV), and 4 patients (4.8%) underwent tracheostomy and received invasive ventilation (TIV). Two patients (2.4%) underwent tracheostomy only without receiving MV. The morphine dosage in patients who received NIV was greater (mean 60 mg (SD 46), range 10–200 mg) than that in patients who did not receive MV (mean 30.3 mg (SD 25.9), range 0–120 mg), and this was statistically significant (p=0.015, Welch’s t-test). In two patients who only received NIV, the affliction relief was insufficient by morphine, and sedative medicine was required.

Morphine usage in our hospital was similar to that reported previously. Although the morphine dosage tended to be greater in patients receiving NIV, the daily dosage of morphine needed for sufficient affliction relief, varied widely. Some patients required only a small dosage of morphine, while some required very large dosages of morphine and sedative medicine. Further study is needed to establish an appropriate protocol for morphine administration in patients with ALS.