Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In their Perspectives on Care at the Close of Life article, Drs Lo and Rubenfeld1 rightly state that palliative sedation is an option of last resort for relieving intractable suffering and that all alternatives should be exhausted before proceeding. The authors note that opioid-induced neurotoxicity may manifest with myoclonus, delirium, and hyperalgesia. We assume that the patient in question was not delirious and had no history of chemical dependence or somatization because these are risk factors for increased pain expression and dose escalation.2,3
Del Fabbro E, Bruera E. Dying Patients and Palliative Sedation. JAMA. 2006;295(11):1249-1250. doi:10.1001/jama.295.11.1249-b