Low Morphine Doses in Opioid-Naive Cancer Patients with Pain

Mercadante, Sebastiano; Porzio, Giampiero; Ferrera, Patrizia; Fulfaro, Fabio; Aielli, Federica; Ficorella, Corrado; Verna, Lucilla; Tirelli, Walter; Villari, Patrizia; Arcuri, Edoardo

doi:10.1016/j.jpainsymman.2006.01.001

Cited by 75 publications

(53 citation statements)

References 21 publications

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“…The results also indicated that morphine is well tolerated. These findings are supported by reports from other studies elsewhere which showed that only a small proportion of patients under morphine therapy stop the drug due to poor response or other reasons (Bercovitch et al, 1999;Mercadante et al, 2006). In this study the caregivers had positive attitude towards the use of morphine and that they followed analgesic ladder recommended by WHO when prescribing and administering morphine to patients (WHO, 1990).…”

Section: Discussionsupporting

confidence: 85%

Rational use and effectiveness of morphine in the palliative care of cancer patients at the Ocean Road Cancer Institute in Dar es salaam, Tanzania

Kamuhabwa

Ezekiel²

2010

Tanzania J Hlth Res

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Morphine and other opioids is the mainstay of cancer pain management. However, considerable fears surrounding their use present barriers to pain control. The aim of this study was to assess the rational use and effectiveness of morphine for management of pain in the palliative care of cancer patients at Ocean Road Cancer Institute (ORCI) in Tanzania. A total of 100 cancer patients who were receiving morphine therapy at the ORCI were interviewed to get information on morphine use. In addition, information on the prescribed doses of morphine was obtained from medical records of 200 patients who have used morphine from September 2005 to April 2006. Both outpatients and inpatients with advanced cancer who were receiving morphine for palliative care were involved. Seven (7) palliative caregivers, including two doctors, two nurses, a pharmacist, a pharmaceutical technician and a social worker were also interviewed. Of the 100 interviewees, 37% were aware of morphine. The level of education and duration of therapy had an impact on the awareness. The results also showed that oral morphine solution was the most common route (96%) of administration. Fifty-seven percent of the patients described the doses of morphine given to be effective in relieving their pain. Although most patients (79%) experienced morphine-induced side effects, the majority (93%) were continuing with the therapy. There were no indication of irrational use of morphine and morphine-induced side effects were well managed. The majority of patients and caregivers had positive attitude towards the use of morphine. In conclusion, the study revealed that the use of morphine is acceptable among a large proportion of patients receiving palliative care and that the majority of them find the doses given effective to relieve their pain. _______________________________________________________________________________________

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Section: Discussionsupporting

confidence: 85%

Rational use and effectiveness of morphine in the palliative care of cancer patients at the Ocean Road Cancer Institute in Dar es salaam, Tanzania

Kamuhabwa

Ezekiel²

2010

Tanzania J Hlth Res

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“…This rate was considered acceptable, given the reported need to switch to other opioids from morphine because of unfavorable responses in the cancer population 20 . The percentage of patients who discontinued TP (7%) seems to be even less than patients treated with oral morphine (13%), transdermal buprenorphine (15%), and transdermal fentanyl (about 14%) reported in previous studies with a similar design and duration [14][15][16] . In studies of non-cancer pain, TP was associated with a lower rate of discontinuation in comparison with oxycodone 7,8,10 .…”

Section: Discussionmentioning

confidence: 69%

“…7 (14) 5 (10) 3 (6) 4 (10) 4 (10) NSAIDs -paracetamol n (%) 7 (14) 2 (4) 3 (6) 2 (5) 4 (10) opioid-naive patients with oral morphine 14 , transdermal buprenorphine 15 , and transdermal fentanyl 16 . The reduced tendency to increase the dose, already observed in animal models 5,6 , may reflect a less toleragen effect of TP, possibly due to its pharmacological characteristics with a dual analgesic mechanism 3 .…”

Section: Discussionmentioning

confidence: 99%

Tapentadol in cancer pain management: a prospective open-label study

Mercadante

Porzio²,

Ferrera

et al. 2012

Current Medical Research and Opinion

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c i a l D i s t r i b u t i o n U n a u t h o r i z e d u s e p r o h i b i t e d . A u t h o r i s e d u s e r s c a n d o w n l o a d , d i s p l a y , v i e w a n d p r i n t a s i n g l e c o p y f o r p e r s o n a l u s eCurrent Medical Research & Opinion Vol. 28, No. 11, 2012, 1775-1779 AbstractObjectives:The aim of this prospective, open-label study was to evaluate the efficacy and tolerability of tapentadol (TP) in the management of cancer pain. Methods:A 4 weeks' prospective study was carried out in 50 opioid-naive cancer patients with moderate-severe pain. Each patient initially received twice-daily doses of slow-release TP 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity, on the basis of the clinical response. The following parameters were recorded at weekly intervals for 4 weeks: pain and opioid-related adverse effects, quality of life measured with the Spitzer score, TP escalation index percent (TPEI%) and TP escalation index in mg (TPEImg), calculated at the end of the study, pain mechanisms, and PainDETECT at baseline. Results:Of 50 patients, 39 completed the entire study and 11 discontinued the treatment for different reasons. Pain intensity significantly decreased from baseline to all the week intervals (p50.0005), and adverse effects did not changed significantly, while quality of life improved. TP escalation indexes were low and no relationship was found with age, gender, and pain mechanisms. Conclusion:Tapentalol started in doses of 100 mg/day was well-tolerated and effective in opioid-naive patients with cancer pain, regardless of the pain mechanism. It can be considered as a flexible drug to be used in patients with moderate-severe pain. Limitations:This was an open-label study for exploratory purposes. Data should be confirmed in controlled studies with a larger number of patients. IntroductionCancer pain management is based on a sequential approach of drugs, as suggested by the WHO, through steps corresponding to drugs with different potencies. Application of the WHO three-step analgesic ladder has been reported to provide satisfactory pain relief in up to 90% of patients with cancer pain 1 . This approach has had an impact of paramount importance in terms of clinical outcome and educational perspective, although evidence is lacking, particularly with regard to possible alternatives, because of the paucity of controlled studies in this field. More recently, studies have examined the role of opioid analgesics and confirmed that more data are necessary 2 . It is anticipated that new drugs will be evaluated in the near future. For personal use only.

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“…The other was where patients either considered their level of pain could be managed without the use of rescue morphine; or introduced to opioids for the first time through this mode of delivery resulted in physical and cognitive effects regarded as intolerable. For opioid naive patients 31 particularly, their experiences of adverse effects resulted in limited use or ended use, at least at this stage in their pain. For those who were opioid tolerant but limited their intake of rescue morphine, we posit that this was as a result of the permissiveness of rescue morphine and that there was a lack of equilibrium in the trade-off between their perceived need for relief and side effects 11 .…”

Section: Discussionmentioning

confidence: 99%