Olav Magnus Søndenå Fredheim

• Gravdahl, Eva-Kristin Norum; Augestad, Knut Magne; Sandblost, Tonje; Clausen, Maria & Fredheim, Olav Magnus Søndenå (2026). Symptom management, outcomes and decision-making in malignant bowel obstruction: a retrospective cohort study. BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2026-006200. Full text in Research Archive
• Johansen, Henriette; Nakken, Ola; Holmøy, Trygve & Fredheim, Olav Magnus Søndenå (2026). Disease trajectories and end of life care in a Norwegian ALS cohort. BMC Neurology. 26(1). doi: 10.1186/s12883-026-04698-8. Full text in Research Archive
• Fredheim, Olav Magnus Søndenå; Gravdahl, Eva-Kristin Norum; Skulberg, Ingeborg M & Magelssen, Morten (2025). Attitudes Toward Euthanasia and Physician-Assisted Suicide Among Norwegian Palliative Care Physicians. Palliative Medicine Reports (PMR). 6(1), p. 415–423. doi: 10.1177/26892820251372012. Full text in Research Archive Show summary

  Background: Data from other countries have indicated that palliative care physicians are more opposed to assisted dying compared with other physicians. However, little is known about reasons for support/opposition among palliative care physicians. Objectives: To explore Norwegian palliative care physicians’ attitudes toward assisted dying, with focus on filling knowledge gaps regarding reasons for support/opposition. Methods: The study is a cross-sectional descriptive survey. All 285 members of the Norwegian Association for Palliative Medicine were invited by e-mail to participate. To allow comparison with previous data, most questions and response alternatives were similar to a 2024 study of Norwegian physicians. Results: Among the 117 respondents opposition toward assisted dying was observed with 85 (73%) strongly disagreeing and 14 (12%) somewhat disagreeing with legalization of physician-assisted suicide for patients with short life expectancy. There was a clear pattern of less support for assisted dying if indications were wider, with only one respondent partially agreeing that assisted dying should be legalized for patients without severe illness who are tired of life and want to die. The most common reason for opposition was assisted dying representing a breach with professional ethics (88 subjects). The most common reason for support was that legalization could provide a safety for patients and next of kin that suffering could be avoided (14 subjects). Discussion: A large majority of Norwegian palliative care physicians reject the legalization of assisted dying. Among the small minority who support assisted dying, most believe it should be limited to patients with a short life expectancy.

• Torvund, Solveig Kristine Kolstad; Thoresen, Lisbeth; Magelssen, Morten & Fredheim, Olav Magnus Søndenå (2025). Conceptual barriers to palliative sedation: insights from focus group interviews with specialist palliative care professionals. BMC Palliative Care. 24(1). doi: 10.1186/s12904-025-01931-y. Full text in Research Archive Show summary

  Palliative sedation is considered an essential measure when other methods cannot provide sufficient symptom control in end-of-life. Prior research suggests that health care professionals find boundaries between palliative sedation, routine symptom management and euthanasia ambiguous. Appropriate implementation of palliative sedation depends on palliative care clinicians being confident in conceptual understanding of palliative sedation. The aim of this study was to understand specialist palliative care professionals' conceptualization of distinctions between symptom management, palliative sedation, and euthanasia; how perceived boundary ambiguities act as barriers to timely initiation of palliative sedation; and potential strategies to overcome these barriers. Methods This is an explorative qualitative phenomenological study, based on focus group interviews, utilizing reflexive thematic analysis. Four focus groups were interviewed at specialist palliative care departments across four Norwegian hospitals. Participants were 11 nurses and 12 physicians with at least one year of experience within specialist palliative care. Results Through thematic analysis two core themes were developed; the distinction between symptom management and palliative sedation, and the distinction between palliative sedation and euthanasia. Important sub-themes were definitional uncertainties, complexity of gradual medication titration, timing of sedation, indications for sedation, communication, and concerns about hastening death. Conclusion Even within specialist palliative care, different end-of-life treatment concepts are not experienced clear-cut. These conceptual ambiguities impede appropriate initiation of palliative sedation. Overcoming such barriers requires multi-level interventions: enhancing practitioners' definitional knowledge, fostering awareness of clinical intention during end-of-life treatment, promoting interprofessional dialogue, and developing more explicit clinical guidelines.

• Klingenberg, Espen; Lindahl, Anne Karin; Brenne, Kathrine; Hagen, Milada & Fredheim, Olav Magnus Søndenå (2025). A Modified Trigger Tool for Identification of Patient Harm in Palliative Care Patients. A Pilot Study From Norway. Journal of patient safety. ISSN 1549-8417. doi: 10.1097/PTS.0000000000001449. Full text in Research Archive Show summary

  The modified trigger tool identifies patient harm and disturbed dying in palliative care patients. However, further development is required before the routine implementation of this tool.

• Gravdahl, Eva-Kristin Norum; Dale, Ola; Benth, Jurate Saltyte; Steine, Siri; Augestad, Knut Magne & Fredheim, Olav Magnus Søndenå (2025). Pharmacokinetics of subcutaneous and intravenous bolus doses of morphine in palliative care cancer patients receiving infusion of morphine: A pharmacokinetic substudy of a randomized controlled trial. British Journal of Clinical Pharmacology. ISSN 0306-5251. 91(12), p. 3422–3431. doi: 10.1002/bcp.70191. Full text in Research Archive Show summary

  Aims To compare the pharmacokinetics of intravenous (IV) and subcutaneous (SC) morphine bolus doses in palliative care patients receiving patient-controlled analgesia. Methods This pharmacokinetic substudy of a double-blinded, randomized controlled trial included 20 patients with advanced cancer requiring morphine infusion. After 20–48 h of patient-controlled analgesia, a baseline blood sample was drawn before bolus administration, followed by 16 samples over 2 h. Time to maximum concentration, maximum concentration and area under the curve to 60 min (AUC0–60) were determined. Group differences were assessed using linear mixed-effects modelling. Results Median (Q1, Q3) time to maximum concentration was significantly shorter for IV (2 [2, 2] min) compared to SC (10 [5, 15] min, P < .001). Dose-adjusted maximum concentration was 3 times higher in the IV group. Linear mixed-effects modelling showed on average, significantly higher serum concentrations for IV during the 0–60 min period postbolus, although differences in AUC0–60 were not statistically significant (mean AUC0–60: SC, 7621 nmol min/L [95% confidence interval: 5714–10 163]; IV, 9382 nmol min/L [95% confidence interval: 5914–14 884]). At steady state, higher infusion rates were associated with markedly higher concentrations in the IV group. Low albumin correlated with higher serum morphine concentrations. No differences in respiratory rates or sedation were observed. Conclusions IV morphine showed faster absorption with substantially higher peak concentrations compared to SC. Further research is needed to assess the clinical relevance of these differences.

• Gravdahl, Eva-Kristin Norum; Steine, Siri; Benth, Jurate Saltyte; Augestad, Knut Magne & Fredheim, Olav Magnus Søndenå (2025). Subcutaneous versus intravenous route switch from oral to parenteral morphine in patients with cancer: Randomised controlled trial. BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2025-005593. Full text in Research Archive
• Materstvedt, Lars Johan & Fredheim, Olav Magnus Søndenå (2025). Lindrende sedering i livets sluttfase: forslag til revisjon av retningslinjene. Michael. ISSN 1893-9651. 22(1), p. 52–59. doi: 10.5617/michael.12113. Full text in Research Archive
• Fredheim, Olav Magnus Søndenå; Torvund, Solveig Kristine Kolstad; Thoresen, Lisbeth & Magelssen, Morten (2024). How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation? Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 68(5), p. 675–680. doi: 10.1111/aas.14396. Full text in Research Archive Show summary

  Background Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position. Aim A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death. Design A structured analysis based on the four principles of healthcare ethics and stakeholders' interests. Results Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions. Conclusion Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.

• Aurén-Møkleby, Eva Margareta; Aasbø, Gunvor; Fredheim, Olav Magnus Søndenå; Mengshoel, Anne Marit; Solbrække, Kari Nyheim & Thoresen, Lisbeth (2024). “It turned out right for both of us”: A qualitative study about a preference for home death and actual place of death. Death Studies. ISSN 0748-1187. doi: 10.1080/07481187.2024.2369847. Full text in Research Archive Show summary

  This qualitative study was conducted in Norway to explore couples’ preference for home death when one of the partners was dying from cancer, and what made home death possible or not. We conducted dyad interviews with five couples. After the patients’ death, the spouses participated in individual interviews. The data were interpreted using thematic narrative analysis. One patient died at home, and three died in a healthcare institution. The narratives show how interdependency and mutual care were important when dealing with home death. When care needs were manageable at home, home was perceived a safe place and the preferred place for death. When care needs were experienced to become unmanageable at home, the sense of safety changed and admission to a health care institution was considered the best option. Regardless of place of death, the spouses experienced the end to have turned out right for their partner and themselves.

• Fredheim, Olav Magnus Søndenå; Klingenberg, Espen & Lindahl, Anne Karin (2024). Prevalence of Triggers and Patient Harm Identified by Global Trigger Tool in Specialized Palliative Care. Journal of Palliative Medicine. ISSN 1096-6218. 27(6), p. 742–748. doi: 10.1089/jpm.2023.0496. Full text in Research Archive
• Gravdahl, Eva-Kristin Norum; Haugen, Dagny Renata Faksvåg & Fredheim, Olav Magnus Søndenå (2024). Use of peripherally inserted central venous catheters and midline catheters for palliative care in patients with cancer: a systematic review. Supportive Care in Cancer. ISSN 0941-4355. 32. doi: 10.1007/s00520-024-08664-3. Full text in Research Archive Show summary

  Background: Peripherally inserted central catheters (PICCs) and midline catheters (MCs) may offer convenient intravenous access, but evidence to support their place in palliative care is limited. This review aimed to assess catheter indications, utilization, complications, dwell time, and patient experiences in cancer patients receiving palliative care. Methods: A systematic search for studies on catheter utilization for supportive or symptom treatment was conducted in Medline, Embase, CINAHL, Web of Science, Cochrane, and CENTRAL databases. Studies with a study population or a subgroup of palliative care cancer patients were included. Study quality was assessed using the Effective Public Health Practice Quality assessment tool. Results: Of 7631 unique titles, 17 articles were examined in detail, all published between 2002 and 2022. Median catheter dwell time varied from 15 to 194 days, the longest when utilized for home parenteral nutrition. For pain and symptom management, the typical duration was 2–4 weeks, often until the patient’s death. Complication rates were minimal, with thrombosis, infections, and occlusion ranging from 0 to 2.46 incidents per 1000 catheter days. In studies from palliative care services, patients reported minimal distress during procedures and high user satisfaction. Quality of life assessments post-procedure improved, possibly influenced by concurrent specialist palliative care provision. All studies were assessed to be of moderate or weak quality. Conclusion: PICC and MC are safe and valuable tools in palliative care cancer patients who would benefit from intravenous access for symptom management. Further studies are needed to clarify indications for PICC or MC in palliative care.

• Fredheim, Olav Magnus Søndenå; Torvund, Solveig Kristine Kolstad & Johansen, Henriette (2023). Mange pasienter med Parkinsons sykdom trenger palliativ behandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(3), p. 212–213. doi: 10.4045/tidsskr.22.0743. Full text in Research Archive
• Gravdahl, Eva-Kristin Norum; Steine, Siri; Augestad, Knut Magne & Fredheim, Olav Magnus Søndenå (2023). Use and safety of peripherally inserted central catheters and midline catheters in palliative care cancer patients: a retrospective review. Supportive Care in Cancer. ISSN 0941-4355. 31. doi: 10.1007/s00520-023-08045-2. Full text in Research Archive Show summary

  Abstract Purpose Some cancer patients in palliative care require intravenous administration of symptom relieving drugs. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) provide easy and accessible intravenous access. However, limited evidence supports the use of these devices in palliative care. The aim was to assess the use, safety, and efficacy of PICC and MC in this patient population. Methods A retrospective study of all palliative care cancer patients who received PICC or MC at the Department of Palliative Medicine at Akershus University Hospital between 2020 and 2022. Results A total of 374 patients were included; 239 patients received a PICC and 135 an MC with a total catheterization duration of 11,698 days. The catheters remained in place until death in 91% of patients, with a median catheter dwell time of 21 days for PICCs and 2 days for MCs. The complication rate was 3.3 per 1000 catheter days, with minor bleeding and accidental dislocation as the most common. The catheters were utilized primarily for opioids and other symptom directed treatments, and 89% of patients received a patient or nurse-controlled analgesia pump. Patients with PICC or MC discharged to home or nursing homes spent 81% of their time out of hospital. Conclusion PICC and MC provide safe parenteral access for palliative care cancer patients where intravenous symptom treatment is indicated. Their use can facilitate intravenous symptom treatment beyond the confines of a hospital and supplement the traditional practice relying on subcutaneous administration.

• Holmberg, Siril T.; Skurtveit, Svetlana; Gulati, Sasha; Salvesen, Øyvind; Nygaard, Øystein P. & Solberg, Tore K. [Show all 7 contributors for this article] (2023). Persistent Use of Prescription Opioids Before and After Lumbar Spine Surgery: Observational Study With Prospectively Collected Data From Two Norwegian National Registries. Spine. ISSN 0362-2436. 48(14), p. 969–977. doi: 10.1097/BRS.0000000000004710. Full text in Research Archive Show summary

  Study design. Prospective pharmacoepidemiologic study Objective. To investigate clinical and sociodemographic factors associated with persistent opioid use in the years following spine surgery among patients with persistent opioid use preceding lumbar spine surgery. Summary of background data. It is unknown whether successful spine surgery leads to a cessation of preoperative persistent opioid use. Methods. Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked for patients operated for degenerative lumbar spine disorders between 2007 and 2017. The primary outcome measure was persistent opioid use in the second year after surgery. Functional disability was measured with the Oswestry Disability Index (ODI). Factors associated with persistent opioid use in the year before, and two years following, surgery were identified using multivariable logistic regression analysis. The variables included in the analysis were selected based on their demonstrated role in prior studies. Results. The prevalence of persistent opioid use was 8.7% in the year before surgery. Approximately two-thirds of patients also met the criteria for persistent opioid use the second year after surgery. Among patients who did not meet the criteria for persistent opioid use the year before surgery, 991 (3.3%) patients developed persistent opioid use in the second year following surgery. The strongest association was exhibited by high doses of benzodiazepines in the year preceding surgery (OR 1.7, 95% CI 1.26 to 2.19, P

• Werff, Hans Fredrik Leendert van der; Michelet, Torstein Hagen; Fredheim, Olav Magnus & Steine, Siri (2022). “Do not resuscitate” order and end-of-life treatment in a cohort of deceased in a Norwegian University Hospital. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 66(8), p. 1009–1015. doi: 10.1111/aas.14104. Full text in Research Archive
• Hamina, Aleksi; Handal, Marte; Fredheim, Olav; Clausen, Thomas; Chen, Li-Chia & Skurtveit, Svetlana Ondrasova (2021). Filled prescriptions for opioids among children and adolescents – A nationwide study from 2010 to 2018. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(10), p. 1475–1483. doi: 10.1111/aas.13968. Full text in Research Archive Show summary

  Objectives Treatment-free remission (TFR) has emerged as a treatment goal in chronic myeloid leukemia in the chronic phase (CML-CP). Attempts to increase proportion of patients achieving TFR include combination of tyrosine kinase inhibitors (TKI) and other drugs. Interferon-α in addition to TKI has shown promising efficacy but with dose-dependent toxicity and discontinuations. NordCML007 was initiated to study the efficacy and safety of low dose pegylated IFN-α (PegIFN-α) in combination with dasatinib (DAS) in CML-CP. Methods Forty patients with newly diagnosed CML-CP were given DAS upfront. After month 3 (M3) 15 μg/wk of PegIFN-α was added and increased to 25 μg/wk from M7 until M15. DAS treatment was continued and adverse events and BCR-ABL1 qRT-PCR values were reported yearly after M24. Results from M1 to M18 have previously been published, and here we present long-term data. Results After 5 years of follow-up, there were no suspected unexpected serious adverse reactions, no increase in serosal effusions, no disease progressions and no CML-related deaths. Rates of MR3.0 (MMR), MR4.0 and MR4.5 were 84.6%, 64.1% and 51.3% respectively at M60, and 95% of patients reached MMR at some point during the study. Conclusion Initial addition of PegIFN-α to DAS shows good long-term efficacy without increased toxicity.

• Fredheim, Olav Magnus; Skurtveit, Svetlana Ondrasova; Sjøgren, Per; Aljabri, Mohammad Belal & Hjellvik, Vidar (2021). Prescriptions of analgesics during chronic cancer disease trajectories: A complete national cohort study. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 30(11), p. 1504–1513. doi: 10.1002/pds.5329. Full text in Research Archive Show summary

  Purpose Pain management principles vary considerably between chronic noncancer, acute and cancer pain. Cancer patients responding to oncological treatment may live with low tumor burden for years. Opioid treatment should reflect that the ratio between benefits and risks in these patients is different from patients with a rapidly progressive disease. Our study investigated the prescription patterns of analgesics in patients who died 6 to 9 years after cancer diagnosis. Patients and methods A pharmaco-epidemiological study based on the Norwegian Prescription Database and Cancer Registry of Norway. The 1-year periodic prevalence of receiving different analgesics and of persistent opioid use were analyzed. Persistent opioid use was defined as >365 Defined Daily Doses or >9000 mg Oral Morphine Equivalents during 365 days with prescriptions in all quarters of the 365 days period. Data were reported for the first 7 years for patients who lived 8–9 years after cancer diagnosis (N = 1502), while for patients who lived 6–7 years (N = 3817) data was reported for the first 5 years after diagnosis. Results Compared to age- and gender adjusted general population, the 1-year periodic prevalence of opioid prescription was doubled the first year after diagnosis and remained raised with approximately 50%. The prevalence of persistent opioid use was threefold of the general population. Approximately 55% of patients with persistent opioid use 4 years after a cancer diagnosis were co-medicated with high doses of benzodiazepines and/or benzodiazepine-related hypnotics. Conclusion The findings of increased opioid use raise concerns regarding whether the benefits outweigh risks and side effects in this population.

• Fredheim, Olav Magnus; Materstvedt, Lars Johan; Skulberg, Ingeborg M & Magelssen, Morten (2021). Ought the level of sedation to be reduced during deep palliative sedation? A clinical and ethical analysis. BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/bmjspcare-2021-003081. Full text in Research Archive Show summary

  Background Deep palliative sedation (DPS) is applied as a response to refractory suffering at the end of life when symptoms cannot be relieved in an awake state. DPS entails a dilemma of whether to provide uninterrupted sedation—in which case DPS would turn into deep and continuous palliative sedation (DCPS) —to minimise the risk that any further intolerable suffering will occur or whether to pause sedation to avoid unnecessary sedation. DPS is problematic in that it leaves the patient ‘socially dead’ by eradicating their autonomy and conscious experiences. Aim To perform a normative ethical analysis of whether guidelines should recommend attempting to elevate consciousness during DPS. Design A structured analysis based on the four principles of healthcare ethics and consideration of stakeholders’ interests. Results When DPS is initiated it reflects that symptom relief is valued above the patient’s ability to exercise autonomy and experience social interaction. However, if a decrease in symptom burden occurs, waking could be performed without patients experiencing suffering. Such pausing of deep sedation would satisfy the principles of autonomy and beneficence. Certain patients require substantial dose increases to maintain sedation. Waking such patients risks causing distressing symptoms. This does not happen if deep sedation is kept uninterrupted. Thus, the principle of non-maleficence points towards not pausing sedation. The authors’ clinical ethics analysis demonstrates why other stakeholders’ interests do not appear to override arguments in favour of providing uninterrupted sedation. Conclusion Stopping or pausing DPS should always be considered, but should not be routinely attempted.

• Holmberg, Siril Therese; Fredheim, Olav Magnus; Skurtveit, Svetlana Ondrasova; Salvesen, Øyvind; Nygaard, Øystein Petter & Gulati, Agnete Malm [Show all 8 contributors for this article] (2021). Persistent Use of Prescription Opioids Following Lumbar Spine Surgery: Observational Study with Prospectively Collected Data from Two Norwegian Nationwide Registries. Spine. ISSN 0362-2436. 47(8), p. 607–614. doi: 10.1097/BRS.0000000000004275. Full text in Research Archive Show summary

  Study Design. Prospective pharmacoepidemiological study Objective. To investigate the use of prescription opioids two years following degenerative lumbar spine surgery. Summary of Background Data. There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use followign some of the most common surgical procedures are lacking. Methods. Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disability was measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017. Results. Among 32886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery. Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (OR 31.10, 95% CI 26.9-36.0, P = .001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P = .001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P = .001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at one year was observed in persistent opioid users compared to non-persistent users (41.5 vs 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at one year compared to non-persistent users (37.7% vs 52.6%, P = .001). Conclusion. Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.

• Fredheim, Olav Magnus; Skurtveit, Svetlana; Loge, Jon Håvard; Sjøgren, Per; Handal, Marte & Hjellvik, Vidar (2020). Prescription of analgesics to long-term survivors of cancer in early adulthood, adolescence and childhood in Norway: a national cohort study. Pain. ISSN 0304-3959. 161(5), p. 1083–1091. doi: 10.1097/j.pain.0000000000001800. Full text in Research Archive Show summary

  Increasing numbers survive cancers in childhood and adolescence. Long-term survivors of cancers in adulthood have increased prevalence of pain and consumption of analgesics. It is not established whether long-term survivors of cancers in childhood and adolescence also have an increased use of analgesics. However, based on increased use of antidepressants and anxiolytics in long-term survivors of cancers in childhood and adolescence, we hypothesized that this group also had increased use of analgesics. Based on data from the 2 nationwide registers, the Cancer Registry of Norway and the Norwegian Prescription Database, a cohort of 5585 (52% males) long-term survivors of cancers in childhood, adolescence, and early adult life was established. Age- and sex-adjusted comparisons were made to the general population. The age-adjusted one-year periodic prevalence of receiving prescriptions of opioids, benzodiazepines, and benzodiazepine-related hypnotics in the study population was increased by 20% to 50%, and the one-year periodic prevalence of receiving prescriptions of gabapentinoids was approximately increased 2-fold compared to the general population. For paracetamol and nonsteroidal anti-inflammatory drugs, no difference was found. For those survivors, who were persistent or high-dose users of opioids, comedication with high doses of benzodiazepines and/or benzodiazepine-related hypnotics was far more common than among persistent and high-dose opioid users in the general population. The high prevalence of gabapentinoids may indicate increased prevalence of neuropathic pain in this group. The high degree of comedication with benzodiazepines and/or benzodiazepine-related hypnotics in survivors on persistent and high-dose opioids might be an indication of problematic opioid use or addiction.

• Fredheim, Olav Magnus; Skulberg, Ingeborg M; Magelssen, Morten & Steine, Siri (2020). Clinical and ethical aspects of palliative sedation with propofol—A retrospective quantitative and qualitative study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 64(9), p. 1319–1326. doi: 10.1111/aas.13665. Full text in Research Archive Show summary

  Background The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. Aim To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation. Methods A retrospective study with quantitative and qualitative data. All patients who during a 4.5‐year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included. Results Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour. Conclusions Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death.

• Gustad, Kristine Espengren; Askjer, Åsta; Nortvedt, Per; Fredheim, Olav Magnus & Magelssen, Morten (2020). Refractory suffering at the end of life and the assisted dying debate: An interview study with palliative care nurses and doctors. Clinical Ethics. ISSN 1477-7509. doi: 10.1177/1477750920946613. Full text in Research Archive Show summary

  Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts were analysed with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved.

• Holmberg, Siril Therese; Salvesen, Øyvind; Vangen-Lønne, Vetle; Hara, Sozaburo; Fredheim, Olav Magnus & Solberg, Tore [Show all 10 contributors for this article] (2020). Pain During Sex Before and After Surgery for Lumbar Disc Herniation - A Multicenter Observational Study. Spine. ISSN 0362-2436. doi: 10.1097/BRS.0000000000003675. Full text in Research Archive Show summary

  Study Design. Observational multicenter study. Objective. The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH). Summary of Background Data. There are limited data available on sexual function in patients undergoing surgery for LDH. Methods. Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain. Results. Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors. Conclusion. This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year. Level of Evidence: 2

• Fredheim, Olav Magnus; Skurtveit, Svetlana; Handal, Marte & Hjellvik, Vidar (2019). A complete national cohort study of prescriptions of analgesics and benzodiazepines to cancer survivors in Norway 10 years after diagnosis. Pain. ISSN 0304-3959. 160(4), p. 852–859. doi: 10.1097/j.pain.0000000000001459. Full text in Research Archive Show summary

  Chronic pain due to surgery, radiotherapy, or chemotherapy is prevalent in long-term cancer survivors. Chronic pain due to successful cancer treatment should be treated as chronic nonmalignant pain, primarily with nonpharmacological strategies. Based on complete national data from the Cancer Registry of Norway and the Norwegian prescription database, the aim of this study was to compare the use of nonopioid analgesics, opioids, and benzodiazepines 10 years after cancer diagnosis in long-term cancer survivors and the age- and sex-adjusted general population. The 1-year periodic prevalence of use was higher in long-term cancer survivors in all the studied drug classes: opioids (143.5 vs 129.6/1000), paracetamol (88.3 vs 80.7/1000), nonsteroidal anti-inflammatory drugs (229.1 vs 221.7), gabapentinoids (13.4 vs 10.0/1000), benzodiazepines (88.3 vs 77.9/1000), and benzodiazepine-like hypnotics (118.1 vs 97.4/1000). The prevalence of persistent and high-dose opioid use (>365 defined daily doses [DDDs] and >730 DDDs, respectively, during 365 days, and prescriptions all quarters of the year) was also higher in the cancer survivors than in the general population (6.5 vs 4.8/1000 for persistent use and 2.7 vs 1.3/1000 for high-dose use). Less than 10% of persistent and high-dose users received only long-acting opioid formulations. Furthermore, most long-term cancer survivors with persistent or high-dose opioid use were also high-dose users (>100 DDDs/year) of either benzodiazepines or benzodiazepine-like hypnotics. It is an issue of concern that most of those using opioids did not adhere to guidelines regarding opioid formulation and comedication with other drugs with addictive properties.

• Fredheim, Olav Magnus & Magelssen, Morten (2019). Etiske dilemmaer ved suicidalitet hos pasienter med kort forventet levetid. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(16), p. 1574–1578. doi: 10.4045/tidsskr.19.0157. Full text in Research Archive Show summary

  BAKGRUNN Enkelte pasienter i palliativ fase med kort forventet levetid gir uttrykk for selvmordsplaner eller utfører alvorlige selvmordsforsøk. I denne situasjonen reises utfordrende etiske spørsmål. Er det rett med tvangstiltak i denne pasientgruppen? Bør det ytes livreddende livsforlengende behandling i etterkant av et selvmordsforsøk? MATERIALE OG METODE Problemstillingen analyseres ved hjelp av en etablert metode for analyse av medisinsk-etiske dilemmaer i seks trinn. RESULTATER Respekt for pasientens autonomi taler for å avstå fra tvangstiltak for å forebygge selvmord hos pasienter i palliativ fase med kort forventet levetid. Siden gjenstående levetid uansett er kort, veier velgjørenhetsprinsippet mindre tungt her enn i andre situasjoner. Dersom alle relevante palliative tiltak allerede er gjennomført, kan også ikke-skade-prinsippet tale for å avstå fra tvangstiltak som kan forlenge en tilstand pasienten opplever som utålelig. Hensyn til pårørende, helsepersonell og samfunnet er ikke tilstrekkelig tungtveiende til å begrunne tvangstiltak. I den akutte fasen umiddelbart etter selvmordsforsøk vil det være rimelig å gjennomføre livreddende tiltak, men når pasienten gjenvinner bevissthet og samtykkekompetanse, bør pasientens eventuelle ønske om å avstå fra videre livsforlengende behandling respekteres på samme måte som hos andre pasienter. FORTOLKNING Prinsippet om respekt for pasientens autonomi bør stå sterkt i situasjoner med kort forventet levetid. Det taler mot bruk av tvangstiltak samt livsforlengende tiltak mot pasientens ønske.

• Birke, Hanne; Ekholm, Ola; Sjøgren, Per; Fredheim, Olav Magnus; Clausen, Thomas & Skurtveit, Svetlana (2019). Tramadol use in Norway: A register-based population study. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 28(1), p. 54–61. doi: 10.1002/pds.4626. Full text in Research Archive Show summary

  Purpose Increasing use of tramadol for chronic non‐cancer pain is concerning since tramadol users may be at risk of developing recurrent opioid use with increasing opioid consumption and co‐medication. Therefore, we investigated a complete national cohort of tramadol users. Methods The study population (154 042 adult individuals in Norway, who redeemed ≥ one tramadol prescription in 2012) was stratified into four groups according to their opioid use 2 years before their first tramadol prescription in 2012 and followed until 2016. Information on all dispensed opioid analgesics, benzodiazepines (BZDs), and BZD‐related Z‐hypnotics were retrieved from the Norwegian Prescription Database. Results Six percent of opioid naïve tramadol users (no opioid use 2 years before tramadol use in 2012) became recurrent users (received opioids annually during 4‐year follow‐up), almost doubled their mean opioid consumption (66 to 108 defined daily doses [DDD]). One‐quarter proceeded to strong opioids or was co‐medicated with BZDs, one‐third with Z‐hypnotics. Among former weak opioid users, 39.8% became recurrent users, 18.7% proceeded to strong opioids, mean opioid consumption increased slightly, one‐third used BZDs, or Z‐hypnotics concurrently. Among former strong opioid and users in palliative care; 61%, 70% became recurrent users and developed a similar prescription pattern (high and increasing mean opioid consumption, 301 to 318, 413 to 430 DDD); half of them proceeded to strong opioids and/or used BZDs or Z‐hypnotics concurrently. Conclusions Many patients who developed recurrent opioid use received prescriptions which substantially conflicted with existing guidelines and might lead to problematic opioid use.

• Nøstdal, Torkjell; Bernklev, Tomm; Fredheim, Olav Magnus; Paddison, Johanna S. & Ræder, Johan (2018). Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales. Quality of Life Research. ISSN 0962-9343. doi: 10.1007/s11136-018-2068-0. Full text in Research Archive Show summary

  Purpose Postoperative fatigue (POF) is an often underestimated problem after surgery. Studies on POF often report fatigue scores without relating this to the clinical relevance for the patients. The aim of this study was to define the cut-off point for clinically significant POF in three commonly applied fatigue scales; the Postoperative Fatigue Scale, Christensen’s Fatigue Scale, and the Chalder Fatigue Questionnaire. The identification of cut-off points will make it possible to indicate whether statistically significant findings of increased fatigue are of clinical relevance. Methods We combined data from day 0 (pre-operatively) and day 1, 3, 6, and 30 after surgery in two fatigue-related studies with 442 patients. In order to define clinically significant fatigue, a key question was added in each questionnaire; “Given your current description of fatigue, would you say it has been of considerable significance to you?”; “Yes/No”. We analysed each scale’s ability to identify clinically significant fatigue, by performing receiver-operating characteristics (ROC) analyses, and calculated the optimal cut-off point between Sensitivity and Specificity. Results The average weighted cut-off point for clinically significant POF when measured with the Postoperative Fatigue Scale was ≥ 50 (scale range 0–100), with Christensen’s Fatigue Scale ≥ 6 (scale range 1–10) and with the Chalder Fatigue Questionnaire ≥ 16 (scale range 0–33). Conclusion In three commonly used fatigue scales, we have identified cut-off points for clinically significant fatigue among patients recovering from surgery. This can be particularly valuable for diagnostic purposes and in treatment evaluation. Further, it may be possible to analyse and review data from earlier studies in light of clinical relevance.

• Fredheim, Olav Magnus Søndenå; Brelin, Siri; Hjermstad, Marianne Jensen; Loge, Jon Håvard; Aass, Nina Kathrine & Johannessen, Tom Børge [Show all 7 contributors for this article] (2017). Prescriptions of analgesics during complete disease trajectories in patients who are diagnosed with and die from cancer within the five-year period 2005-2009. European Journal of Pain. ISSN 1090-3801. 21(3), p. 530–540. doi: 10.1002/ejp.956. Full text in Research Archive
• Nøstdal, Torkjell; Fredheim, Olav Magnus; Bernklev, Tomm; Doksrød, Tron Simen; Mohus, Randi Marie & Ræder, Johan (2017). A randomised controlled trial of propofol vs. thiopentone and desflurane for fatigue after laparoscopic cholecystectomy. Anaesthesia. ISSN 0003-2409. 72(7), p. 864–869. doi: 10.1111/anae.13909. Full text in Research Archive
• Fredheim, Olav Magnus; Skurtveit, Svetlana & Borchgrevink, Petter Chr. (2017). Utlevering av analgetika til barn f?r og etter nye anbefalinger om kodein. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(12). doi: 10.4045/tidsskr.16.0717. Full text in Research Archive
• Nøstdal, Torkjell; Bernklev, Tomm; Ræder, Johan; Sandvik, Leiv & Fredheim, Olav Magnus (2016). Postoperative fatigue translation and validation of a revised 10-item short form of the Identity-Consequence Fatigue Scale (ICFS). Journal of Psychosomatic Research. ISSN 0022-3999. 84, p. 1–7. doi: 10.1016/j.jpsychores.2016.03.002. Full text in Research Archive
• Fredheim, Olav Magnus; Hansen, Thor Willy Ruud; Haugen, Guttorm & Magelssen, Morten (2016). Bør man kunne tilby keisersnitt ved trisomi 13 og 18? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(7), p. 630–632. doi: 10.4045/tidsskr.15.0037. Full text in Research Archive
• Mellbye, Andreas; Borchgrevink, Petter Chr.; Skurtveit, Svetlana & Fredheim, Olav Magnus (2016). Hva vet vi om bruken av opioider ved ikke-malign smerte? : resultater fra studier basert på Reseptregisteret 2004-2014. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. 124(3), p. 25–30. Full text in Research Archive
• Mellbye, Andreas; Karlstad, Øystein; Skurtveit, Svetlana; Borchgrevink, Petter Chr. & Fredheim, Olav Magnus (2016). The duration and course of opioid therapy in patients with chronic non-malignant pain. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 60(1), p. 128–137. doi: 10.1111/aas.12594. Full text in Research Archive
• Brelin, Siri; Fredheim, Olav Magnus; Loge, Jon Håvard; Skurtveit, Svetlana; Johannesen, Tom Børge & Aass, Nina Kathrine [Show all 8 contributors for this article] (2016). Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study. Journal of Opioid Management. ISSN 1551-7489. 12(1), p. 25–36. doi: 10.5055/jom.2016.0309. Full text in Research Archive
• Fredheim, Olav Magnus; Mahic, Milada; Skurtveit, Svetlana & Borchgrevink, Petter Chr. (2015). Use of nasal fentanyl for cancer pain: A pharmacoepidemiological study. Palliative Medicine. ISSN 0269-2163. 29(7), p. 661–666. doi: 10.1177/0269216315575252. Full text in Research Archive
• Pedersen, Line & Fredheim, Olav Magnus (2015). Opioids for chronic noncancer pain: Still no evidence for superiority of sustained-release opioids. Clinical Pharmacology and Therapeutics. ISSN 0009-9236. 97(2), p. 114–115. doi: 10.1002/cpt.26. Full text in Research Archive
• Dale, Ola; Borchgrevink, Petter Chr.; Fredheim, Olav Magnus; Mahic, Milada; Romundstad, Pål Richard & Skurtveit, Svetlana (2015). Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids. BMC Public Health. 15(461). doi: 10.1186/s12889-015-1774-6. Full text in Research Archive Show summary

  Background: There are concerns about potential increasing use of over-the-counter (OTC) analgesics. The aims of this study were to examine 1) the prevalence of self-reported use of OTC analgesics; 2) the prevalence of combining prescription analgesics drugs with OTC analgesics and 3) whether lifestyle factors such as physical activity were associated with prevalence of daily OTC analgesic use. Methods: Questionnaire data from the Nord–Trøndelag health study (HUNT3, 2006–08), which includes data from 40,000 adult respondents. The questionnaire included questions on use of OTC analgesics, socioeconomic conditions, health related behaviour, symptoms and diseases. Data were linked to individual data from the Norwegian Prescription Database. A logistic regression was used to investigate the association between different factors and daily use of paracetamol and/or non-steroid anti-inflammatory drugs (NSAIDs) in patients with and without chronic pain. Results: The prevalence of using OTC analgesics at least once per week in the last month was 47%. Prevalence of paracetamol use was almost 40%, compared to 19% and 8% for NSAIDs and acetylsalicylic acid (ASA), respectively. While the use of NSAIDs decreased and the use of ASA increased with age, paracetamol consumption was unaffected by age. Overall more women used OTC analgesics. About 3-5% of subjects using OTC analgesics appeared to combine these with the same analgesic on prescription. Among subjects reporting chronic pain the prevalence of OTC analgesic use was almost twice as high as among subjects without chronic pain. Subjects with little physical activity had 1.5-4 times greater risk of daily use of OTC compared to physically active subjects. Conclusions: Use of OTC analgesics is prevalent, related to chronic pain, female gender and physical inactivity.

• Hansen, Anneli Borge; Skurtveit, Svetlana; Borchgrevink, Petter Chr.; Dale, Ola; Romundstad, Pål Richard & Mahic, Milada [Show all 7 contributors for this article] (2015). Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 59(10), p. 1355–1366. doi: 10.1111/aas.12568. Full text in Research Archive
• Mellbye, Andreas; Karlstad, Øystein; Skurtveit, Svetlana; Borchgrevink, Petter Chr. & Fredheim, Olav Magnus (2014). Co-morbidity in persistent opioid users with chronic non-malignant pain in Norway. European Journal of Pain. ISSN 1090-3801. 18(8), p. 1083–1093. doi: 10.1002/j.1532-2149.2014.00449.x. Full text in Research Archive
• Pedersen, Line; Borchgrevink, Petter Chr.; Riphagen, Ingrid Ingeborg & Fredheim, Olav Magnus (2014). Long- or short-acting opioids for chronic non-malignant pain? A qualitative systematic review. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 58(4), p. 390–401. doi: 10.1111/aas.12279. Full text in Research Archive
• Mahic, Milada; Fredheim, Olav Magnus; Borchgrevink, Petter Chr. & Skurtveit, Svetlana (2014). Use of prescribed opioids by children and adolescents: Differences between Denmark, Norway and Sweden. European Journal of Pain. ISSN 1090-3801. 19(8), p. 1095–1100. doi: 10.1002/ejp.632. Full text in Research Archive
• Fredheim, Olav Magnus; Mahic, Milada; Skurtveit, Svetlana; Dale, Ola; Romundstad, Pål Richard & Borchgrevink, Petter Chr. (2014). Chronic pain and use of opioids: A population-based pharmacoepidemiological study from the Norwegian Prescription Database and the Nord-Trøndelag Health Study. Pain. ISSN 0304-3959. 155(7), p. 1213–1221. doi: 10.1016/j.pain.2014.03.009. Full text in Research Archive
• Svendsen, Kristian; Fredheim, Olav Magnus; Romundstad, Pål Richard; Borchgrevink, Petter Chr. & Skurtveit, Svetlana (2014). Persistent opioid use and socio-economic factors: A population-based study in Norway. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 58(4), p. 437–445. doi: 10.1111/aas.12281. Full text in Research Archive
• Pedersen, Line; Borchgrevink, Petter Chr.; Breivik, Harald & Fredheim, Olav Magnus (2014). A randomized, double-blind, double-dummy comparison of short- and long-acting dihydrocodeine in chronic non-malignant pain. Pain. ISSN 0304-3959. 155(5), p. 881–888. doi: 10.1016/j.pain.2013.12.016. Full text in Research Archive
• Skollerud, Lars Morten; Fredheim, Olav Magnus; Svendsen, Kristian; Skurtveit, Svetlana & Borchgrevink, Petter Chr. (2013). Laxative prescriptions to cancer outpatients receiving opioids: a study from the Norwegian prescription database. Supportive Care in Cancer. ISSN 0941-4355. 21(1), p. 67–73. doi: 10.1007/s00520-012-1494-8. Full text in Research Archive
• Fredheim, Olav; Borchgrevink, Petter; Mahic, Milada & Skurtveit, Svetlana (2013). A pharmacoepidemiological cohort study of subjects starting strong opioids for nonmalignant pain: A study from the Norwegian Prescription Database. Pain. ISSN 0304-3959. 154(11), p. 2487–2493. doi: 10.1016/j.pain.2013.07.033. Full text in Research Archive
• Rognstad, May Karin; Fredheim, Olav Magnus; Johannessen, Tone E.Brenne; Kvarstein, Gunnvald; Skauge, Marta & Undall, Eva [Show all 7 contributors for this article] (2012). Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. 26(3), p. 545–552. doi: 10.1111/j.1471-6712.2011.00964.x. Full text in Research Archive
• Pedersen, Line; Hansen, Anneli Borge; Svendsen, Kristian; Skurtveit, Svetlana; Borchgrevink, Petter Chr. & Fredheim, Olav Magnus (2012). Analgetika med refusjon ved kroniske smerter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132(22), p. 2489–2493. doi: 10.4045/tidsskr.11.1214. Full text in Research Archive
• Fredheim, Olav Magnus & Materstvedt, Lars Johan (2012). Behandlingsbegrensning på operasjonsstuen? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. p. 1361–1363. doi: 10.4045/tidsskr.11.1517. Full text in Research Archive Show summary

  Når man under en akutt operasjon innser at pasienten ikke kan kureres og har svært kort forventet levetid, reises viktige spørsmål om avslutning av behandling. Vi drøfter her kliniske og etiske aspekter ved en slik situasjon, særlig om det bør være et mål at pasienten får anledning til å gjenvinne bevisstheten.

• Svendsen, Kristian; Skurtveit, Svetlana; Romundstad, Pål Richard; Borchgrevink, Petter Chr. & Fredheim, Olav Magnus (2012). Differential patterns of opioid use: Defining persistent opioid use in a prescription database. European Journal of Pain. ISSN 1090-3801. 16(3), p. 359–369. doi: 10.1002/j.1532-2149.2011.00018.x. Full text in Research Archive
• Fredheim, Olav Magnus; Husby, Kristin Moksnes; Borchgrevink, Petter Chr. & Skurtveit, Svetlana (2012). Opioid switching to methadone: A pharmacoepidemiological study from a national prescription database. Palliative Medicine. ISSN 0269-2163. 26(6), p. 804–812. doi: 10.1177/0269216311412415. Full text in Research Archive
• Nordbø, Arve; Skurtveit, Svetlana; Borchgrevink, Petter Chr.; Kaasa, Stein & Fredheim, Olav Magnus (2012). Low-dose transdermal buprenorphine - long-term use and co-medication with other potentially addictive drugs. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 56(1), p. 88–94. doi: 10.1111/j.1399-6576.2011.02537.x. Full text in Research Archive
• Mellbye, Andreas; Svendsen, Kristian; Borchgrevink, Petter Chr.; Skurtveit, Svetlana & Fredheim, Olav Magnus (2012). Concomitant medication among persistent opioid users with chronic non-malignant pain. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 56(10), p. 1267–1276. doi: 10.1111/j.1399-6576.2012.02766.x. Full text in Research Archive
• Fredheim, Olav Magnus; Borchgrevink, Petter Chr. & Kvarstein, Gunnvald (2011). Behandling av postoperativ smerte i sykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131(18), p. 1772–1776. doi: 10.4045/tidsskr.10.1184. Full text in Research Archive
• Skurtveit, Svetlana; Furu, Kari; Borchgrevink, Petter Chr.; Handal, Marte & Fredheim, Olav Magnus (2011). To what extent does a cohort of new users of weak opioids develop persistent or probable problematic opioid use? Pain. ISSN 0304-3959. 152(7), p. 1555–1561. doi: 10.1016/j.pain.2011.02.045. Full text in Research Archive
• Fredheim, Olav Magnus; Kvarstein, Gunnvald; Undall, Eva; Stubhaug, Audun; Rustøen, Tone & Borchgrevink, Petter Chr. (2011). Postoperativ smerte hos pasienter innlagt i norske sykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 18(131), p. 1763–1767. doi: 10.4045/tidsskr.10.1129. Full text in Research Archive
• Fredheim, Olav Magnus; Borchgrevink, Petter Chr.; Nordstrand, Berit; Clausen, Thomas & Skurtveit, Svetlana (2011). Prescription of analgesics to patients in opioid maintenance therapy: A pharmacoepidemiological study. Drug and Alcohol Dependence. ISSN 0376-8716. 116(1-3), p. 158–162. doi: 10.1016/j.drugalcdep.2010.12.014. Full text in Research Archive
• Svendsen, Kristian; Borchgrevink, Petter Chr.; Fredheim, Olav Magnus; Hamunen, K; Melbye, Arne Christian & Dale, Ola (2011). Choosing the unit of measurement counts: The use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliative Medicine. ISSN 0269-2163. 25(7), p. 725–732. doi: 10.1177/0269216311398300. Full text in Research Archive
• Fredheim, Olav Magnus; Nøstdahl, Torkjell; Nordstrand, Berit; Høivik, Tone Gulli; Rygnestad, Tarjei & Borchgrevink, Petter Chr. (2010). Behandling av akutte smerter under legemiddelassistert rehabilitering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(7), p. 738–740. Full text in Research Archive
• Fredheim, Olav Magnus S; Skurtveit, Svetlana; Breivik, Harald & Borchgrevink, Petter C (2010). Increasing use of opioids from 2004 to 2007-Pharmacoepidemiological data from a complete national prescription database in Norway. European Journal of Pain. ISSN 1090-3801. 14(3), p. 289–294. doi: 10.1016/j.ejpain.2009.05.006. Full text in Research Archive
• Fredheim, Olav Magnus S; Log, Tomas; Olsen, Wenche; Skurtveit, Svetlana; Sagen, Øystein & Borchgrevink, Petter C (2010). Prescriptions of opioids to children and adolescents; a study from a national prescription database in Norway. Pediatric Anaesthesia. ISSN 1155-5645. 20(6), p. 537–544. doi: 10.1111/j.1460-9592.2010.03310.x. Full text in Research Archive
• Fredheim, Olav Magnus; Dale, Ola; Kaasa, Stein & Borchgrevink, Petter Chr. (2010). Morfin eller oksykodon tabletter mot smerter? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(15), p. 1479–1481. doi: 10.4045/tidsskr.09.1143. Full text in Research Archive
• Borchgrevink, Petter Chr.; Fredheim, Olav Magnus; Fors, Egil Andreas; Holen, Are & Stiles, Tore C (2009). Hva er sammensatte lidelser? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(13), p. 1368–1368. Full text in Research Archive
• Fredheim, OM; Skurtveit, Svetlana; Moroz, A; Breivik, H & Borchgrevink, PC (2009). Prescription pattern of codeine for non-malignant pain: a pharmacoepidemiological study from the Norwegian Prescription Database. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 53(5), p. 627–633. doi: 10.1111/j.1399-6576.2009.01910.x. Full text in Research Archive

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• Gravdahl, Eva-Kristin Norum; Fredheim, Olav Magnus Søndenå & Haugen, Dagny Faksvåg (2024). Use of peripherally inserted central venous catheters and midline catheters in palliative care cancer patients. A systematic review. Full text in Research Archive
• Materstvedt, Lars Johan & Fredheim, Olav Magnus Søndenå (2023). Lindrende sedering er avansert helsehjelp til døende. Full text in Research Archive Show summary

  Lindrende sedering er svært viktig for å sikre god lindring i livets slutt, også i de vanskeligste tilfellene. Slik avansert helsehjelp bør ikke betraktes som etisk problematisk, men snarere som en etisk plikt når lidelsen ikke kan avhjelpes på annen måte.

• Fredheim, Olav Magnus; Kaasa, Stein & Borchgrevink, Petter Chr. (2019). Smertebehandling ved kronisk kreftsykdom. 139(13). doi: 10.4045/tidsskr.19.0226. Full text in Research Archive
• Fredheim, Olav Magnus (2018). Smertebehandling hos kreftpasienter i legemiddelassistert rehabilitering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(2). doi: 10.4045/tidsskr.17.0171. Full text in Research Archive
• Fredheim, Olav Magnus; Hansen, Thor Willy Ruud; Haugen, Guttorm & Magelssen, Morten (2016). O. Fredheim og medarbeidere svarer :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(11), p. 980–981. doi: 10.4045/tidsskr.16.0488. Full text in Research Archive
• Fredheim, Olav Magnus; Hansen, Thor Willy Ruud; Haugen, Guttorm & Magelssen, Morten (2016). Re: Keisersnitt ved trisomi 13 og 18 - en verdibasert vurdering :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(14/15), p. 1187–1187. doi: 10.4045/tidsskr.16.0660. Full text in Research Archive
• Fredheim, Olav Magnus; Hansen, Thor Willy Ruud; Haugen, Guttorm & Magelssen, Morten (2016). O. Fredheim og medarbeidere svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(10), p. 893–893. doi: 10.4045/tidsskr.16.0440. Full text in Research Archive
• Hansen, AB; Borchgrevink, Petter Chr.; Skurtveit, S; Romundstad, Pål Richard & Fredheim, Olav Magnus (2016). Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 60(2), p. 276–276. doi: 10.1111/aas.12645. Full text in Research Archive
• Fredheim, Olav Magnus (2014). Et forsvar for det uforsvarlige. [Journal]. Morgenbladet. Full text in Research Archive
• Fredheim, Olav Magnus (2011). Forekomst av postoperativ smerte. Full text in Research Archive
• Skurtveit, Svetlana; Furu, Kari; Handal, Marte; Borchgrevin, Petter & Fredheim, Olav Magnus (2011). To Which Extent Does a Cohort of New Users of Weak Opioids Develop Persistent or Probable Problematic Opioid Use? Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 20, p. S223–S223. Full text in Research Archive
• Fredheim, Olav Magnus & Borchgrevink, Petter Chr. (2011). Dødshjelp er ikke livshjelp. Vårt land. ISSN 0805-5424. p. 18–18. Full text in Research Archive
• Magelssen, Morten & Fredheim, Olav Magnus (2011). En åndelig dimensjon er viktig for mange pasienter. 131(2), p. 138–140. doi: 10.4045/tidsskr.10.0924. Full text in Research Archive
• Fredheim, Olav Magnus & Magelssen, Morten (2011). Hvorfor reservasjonsrett for helsepersonell? Full text in Research Archive
• Magelssen, Morten & Fredheim, Olav Magnus (2011). Når bør leger ha reservasjonsrett? 131(24), p. 2518–2519. Full text in Research Archive
• Mellbye, Andreas; Svendsen, Kristian; Fredheim, Olav Magnus; Skurtveit, Svetlana & Borchgrevink, Petter Chr. (2010). Low persistent use of prescription opioids in Norway but high degree of co-medication with anxiolytics and hypnotics. Full text in Research Archive
• Svendsen, Kristian; Fredheim, Olav Magnus; Romundstad, Pål Richard; Borchgrevink, Petter Chr. & Skurtveit, Svetlana (2010). Defining persistent opioid use from prescription registries. Full text in Research Archive
• Svendsen, Kristian; Moroz, Anna; Fredheim, Olav Magnus; Skurtveit, Svetlana & Borchgrevink, Petter Chr. (2010). Longitudinal study of new non-cancer users of prescribed strong opioids. Full text in Research Archive
• Fredheim, Olav Magnus; Skurtveit, Svetlana; Breivik, Harald; Svendsen, Kristian; Kaasa, Stein & Borchgrevink, Petter Chr. (2010). Cancer patients acount for only 3% of patients receiving opioids in Norway. Full text in Research Archive
• Fredheim, Olav Magnus (2010). Muskelfysiologi og kronisk smerte. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(22), p. 2271–2272. Full text in Research Archive
• Fredheim, Olav Magnus (2010). Sjekklister – ikke bare for nevrotikere. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(21), p. 2155–2155. Full text in Research Archive
• Fredheim, Olav Magnus; Svendsen, Kristian; Mellbye, Andreas; Hamunen, Katri; Borchgrevink, Petter Chr. & Dale, Ola (2010). Monitoring the opioid consumption: morphine-equivalent defined daily dose as a supplement to DDD. Full text in Research Archive
• Fredheim, Olav Magnus; Log, Tomas; Olsen, Walther; Skurtveit, Svetlana; Sagen, Øystein & Borchgrevink, Petter Chr. (2010). Prescriptions of opioids to children and adolescents; a study from a national prescription database in Norway. Full text in Research Archive
• Fredheim, Olav Magnus; Skurtveit, Svetlana; Breivik, Harald; Svendsen, Kristian; Kaasa, Stein & Borchgrevink, Petter Chr. (2010). A revision of EAPC and WHO three step analgesic ladder may be needed. Full text in Research Archive
• Fredheim, Olav Magnus; Borchgrevink, Petter Chr.; Nordstrand, Berit; Clausen, Thomas & Skurtveit, Svetlana (2010). Prescription of analgesics to patients in opioid maintenance therapy - a pharmacoepidemiological study. Full text in Research Archive
• Nordbø, Arve; Skurtveit, Svetlana; Borchgrevink, Petter Chr.; Kaasa, Stein & Fredheim, Olav Magnus (2010). Is transdermal buprenorphine for chronic non-malignant pain used long term without co-medication with other potentially addictive drugs? Full text in Research Archive
• Skurtveit, Svetlana; Furu, Kari; Handal, Marte; Borchgrevink, Petter Chr. & Fredheim, Olav Magnus (2010). To which extent does incident and persistent use of weak opioids predict problematic opioid use? Full text in Research Archive
• Svendsen, Kristian; Borchgrevink, Petter Chr.; Fredheim, Olav Magnus & Skurtveit, Svetlana (2010). How are opioids used in Norway? Persistent use, utilization of depot formulation and age profile in non-palliation patients. Full text in Research Archive
• Magelssen, Morten & Fredheim, Olav Magnus (2010). Det bestes fiende. Full text in Research Archive Show summary

  Om argumenter i surrogatidebatten

• Fredheim, Olav Magnus; Skurtveit, Svetlana; Breivik, Harald; Svendsen, Kristian; Kaasa, Stein & Borchgrevink, Petter Chr. (2010). A revision of EAPC and WHO three step analgesic ladder may be needed. Palliative Medicine. ISSN 0269-2163. 24(4), p. 119–119. Full text in Research Archive
• Fredheim, Olav Magnus; Skurtveit, Svetlana; Breivik, Harald; Svendsen, Kristian; Kaasa, Stein & Borchgrevink, Petter Chr. (2010). Cancer patients acount for only 3% of patients receiving opioids in Norway. Palliative Medicine. ISSN 0269-2163. 24(4), p. 157–157. Full text in Research Archive
• Svendsen, Kristian; Mellbye, Andreas; Fredheim, Olav Magnus; Borchgrevink, Petter Chr.; Rønning, Marit & Skurtveit, Svetlana [Show all 7 contributors for this article] (2009). Monitoring the opioid consumption: Morphine-equivalent defined daily dose as a supplement to DDD. Full text in Research Archive
• Svendsen, Kristian; Mellbye, Andreas; Hamunen, Katri; Fredheim, Olav Magnus; Borchgrevink, Petter Chr. & Dale, Ola (2009). Monitoring the opioid consumption: Morphine-equivalent defined daily dose as a supplement to DDD. Full text in Research Archive
• Fredheim, Olav Magnus (2009). 2000 nordmenn har et Paralgin-problem. [Journal]. VG. Full text in Research Archive

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