Background: In a multicenter study, 28 patients with cancer pain and insuff
icient pain relief with analgesic treatment according to step II of the gui
delines of the World Health Organization (WHO) were switched to oral slow-r
elease morphine.
Methods: Patients received intravenous morphine through a patient-controlle
d pump (PCA) for the first 24 hours (bolus = 1 mg, lockout interval = 5 min
utes, maximum dose = 12 mg/hour). From day 2 patients were treated with ora
l slow-release morphine. Daily doses were calculated from the requirements
of the day before. Breakthrough pain was treated with PCA until stable dose
s were reached (<2 boluses/day) and then with oral immediate-release morphi
ne solution. Pain intensity was reported in a diary four times a day, in ad
dition to mood, activity, and quality of sleep once daily.
Results: Mean duration until adequate pain relief reported (<30 on a 101-st
ep numerical scale; NRS) was 5 hours (range = 80-620 minutes). Mean pain in
tensity was reduced from 67 NRS to 22 NRS. Mean doses of oral morphine were
133 mg/day initially and then 154 mg/day on day 14. Serious adverse events
such as respiratory depression were not observed. Two patients terminated
the study due to progressive symptoms of gastrointestinal obstruction. Seve
nty-five percent of the patients evaluated the effectiveness of the analges
ic regime as good.
Conclusions: Dose finding with intravenous PCA may be appropriate for a sma
ll minority of patients with severe pain. Higher treatment costs and the ri
sk of complications are drawbacks of this method compared with conventional
oral titration.