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. 1989 Mar 15;140(6):653-7, 661.

Control of severe pain with sustained-release morphine tablets v. oral morphine solution.

W W Arkinstall 1, B R Goughnour 1, J A White 1, J H Stewart 1
PMCID: PMC1268755  PMID: 2645988

Abstract

Recently a sustained-release morphine sulfate tablet (MS Contin [MSC]) was introduced in Canada. In a randomized double-blind crossover trial we compared MSC given every 12 hours with a morphine sulfate solution (MSS) given every 4 hours to 17 patients suffering from chronic severe pain. After titration of the morphine dosage to optimize the analgesic effect, each patient received 10 days of therapy with either MSC or MSS, then 10 days of therapy with an equal daily dose of the other formulation. Both preparations provided effective pain control, with minimal side effects. There was no significant difference between MSC and MSS in pain scores on a visual analogue scale (VAS), severity scores for tiredness and nausea, amount of supplemental morphine needed for break-through pain or patient preference. The plasma morphine concentrations tended to be greater during treatment with MSC. The study had an 89% probability of detecting a clinically significant difference in VAS pain scores. We conclude that an individualized, twice-daily regimen of MSC is as effective as MSS given every 4 hours for control of severe pain. The twice-daily regimen has several advantages: it provides for an uninterrupted night's sleep, it is substantially more convenient than the six doses per day required with MSS, and it should help reduce both medication errors and noncompliance.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ellis E. F. Theophylline. Clin Rev Allergy. 1983 Mar;1(1):73–85. doi: 10.1007/BF02991318. [DOI] [PubMed] [Google Scholar]
  2. Foley K. M. The treatment of cancer pain. N Engl J Med. 1985 Jul 11;313(2):84–95. doi: 10.1056/NEJM198507113130205. [DOI] [PubMed] [Google Scholar]
  3. Hanks G. W., Twycross R. G., Bliss J. M. Controlled release morphine tablets: a double-blind trial in patients with advanced cancer. Anaesthesia. 1987 Aug;42(8):840–844. doi: 10.1111/j.1365-2044.1987.tb04107.x. [DOI] [PubMed] [Google Scholar]
  4. Homesley H. D., Welander C. E., Muss H. B., Richards F. Dosage range study of morphine sulfate controlled-release. Am J Clin Oncol. 1986 Oct;9(5):449–453. doi: 10.1097/00000421-198610000-00018. [DOI] [PubMed] [Google Scholar]
  5. Levy M. H. Pain management in advanced cancer. Semin Oncol. 1985 Dec;12(4):394–410. [PubMed] [Google Scholar]
  6. McGivney W. T., Crooks G. M. The care of patients with severe chronic pain in terminal illness. JAMA. 1984 Mar 2;251(9):1182–1188. [PubMed] [Google Scholar]
  7. Meed S. D., Kleinman P. M., Kantor T. G., Blum R. H., Savarese J. J. Management of cancer pain with oral controlled-release morphine sulfate. J Clin Pharmacol. 1987 Feb;27(2):155–161. doi: 10.1002/j.1552-4604.1987.tb02177.x. [DOI] [PubMed] [Google Scholar]
  8. Melzack R., Mount B. M., Gordon J. M. The Brompton mixture versus morphine solution given orally: effects on pain. Can Med Assoc J. 1979 Feb 17;120(4):435–438. [PMC free article] [PubMed] [Google Scholar]
  9. Melzack R., Ofiesh J. G., Mount B. M. The Brompton mixture: effects on pain in cancer patients. Can Med Assoc J. 1976 Jul 17;115(2):125–129. [PMC free article] [PubMed] [Google Scholar]
  10. Rachelefsky G. S., Katz R. M., Siegel S. C. A sustained release theophylline preparation: efficacy in childhood asthma with low serum theophylline levels. Ann Allergy. 1978 Apr;40(4):252–257. [PubMed] [Google Scholar]
  11. Tabachnik E., Scott P., Correia J., Isles A., MacLeod S., Newth C., Levison H. Sustained-release theophylline: a significant advance in the treatment of childhood asthma. J Pediatr. 1982 Mar;100(3):489–492. doi: 10.1016/s0022-3476(82)80467-8. [DOI] [PubMed] [Google Scholar]
  12. Todd R. D., Muldoon S. M., Watson R. L. Determination of morphine in cerebrospinal fluid and plasma by high-performance liquid chromatography with electrochemical detection. J Chromatogr. 1982 Oct 8;232(1):101–110. doi: 10.1016/s0378-4347(00)86012-0. [DOI] [PubMed] [Google Scholar]
  13. Tuttle C. B. Drug management of pain in cancer patients. Can Med Assoc J. 1985 Jan 15;132(2):121–134. [PMC free article] [PubMed] [Google Scholar]
  14. Ventaffrida V., Oliveri E., Caraceni A., Spoldi E., De Conno F., Saita L., Ripamonti G. A retrospective study on the use of oral morphine in cancer pain. J Pain Symptom Manage. 1987 Spring;2(2):77–81. doi: 10.1016/s0885-3924(87)80019-2. [DOI] [PubMed] [Google Scholar]
  15. Ventafridda V., Tamburini M., Caraceni A., De Conno F., Naldi F. A validation study of the WHO method for cancer pain relief. Cancer. 1987 Feb 15;59(4):850–856. doi: 10.1002/1097-0142(19870215)59:4<850::aid-cncr2820590432>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]

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