Moriarty 1999

Methods	Allocation: randomised Blindness: double‐blind, double‐dummy Duration: 6 days (with run‐in period of 1 to 3 days) Funding: not stated Setting: not stated. Unclear if these were inpatients or community patients. Design: cross‐over
Participants	Diagnosis: people with cancer pain n = 100 Age: not stated Sex: men 53; women 47 History: most common of primary malignancies presented by participants were lung, breast, gastrointestinal and genitourinary. Included: people aged ≥ 18 years, with cancer and achieving pain control with CR morphine sulphate Exclusion: people with significant respiratory depression; severe renal or hepatic impairment; people taking strong opioid analgesics other than 12‐hourly morphine sulphate, and people taking monoamine oxidase inhibitors currently or within the previous 2 weeks; pregnant (or not adequately protected from becoming pregnant) or lactating women. Consent: no details
Interventions	Hydromorphone CR 4 mg Morphine CR 30 mg
Outcomes	Pain VAS Adverse events Treatment preference Use of rescue medication
Notes	No pre‐cross‐over data available. No contact details available to request necessary information. We are also unclear about the intensity of people's cancer pain. This review only intended to include people with moderate to severe cancer pain.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "...according to a randomisation schedule previously prepared by the clinical supplies department at Napp Laboratories Limited..." Comment: third‐party randomisation was used and is likely to be low risk of bias
Allocation concealment (selection bias)	Low risk	Third‐party randomisation was used, thus we considered allocation concealment is likely to have been done
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "Marched placebos were taken throughout to maintain the blinding of the study (double‐dummy technique)"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not described
Incomplete outcome data (attrition bias) All outcomes	Low risk	11 people left the study early and were not included in the final analysis. Although the dropout rate was marginally > 10%, it is unlikely to have had a biased effect on the results, as reasons and proportion for dropout were given and comparable between groups
Selective reporting (reporting bias)	Low risk	None obvious
Other bias	High risk	1 of the study authors is an employee of Napp Laboratories Ltd, a pharmaceutical company that produces analgesics Sample size small, 100 participants in total in the 2 arms