Deschamps 1992.

Methods	Design: randomised, double blind (double dummy), two‐period cross‐over study with titration phase Duration 2 x 7 days, no washout Setting: outpatients
Participants	Metastatic cancer with pain requiring opioids N = 20 Mean age 57 years (range 40 to 72)
Interventions	Mm/r 30, 60, 100 mg, given 12‐hourly (8 am and 8 pm) MIR 1 mg/ml and 5 mg/ml, given 4‐hourly with double dose at night No dose adjustment allowed after titration MIR (solution) for breakthrough; no other opioids/analgesics allowed
Outcomes	PI: 100 mm VAS Adverse events: verbal (6‐point) severity scale Participant preference
Notes	Oxford Quality Score: R = 2, DB = 2, W = 1. Total = 5/5
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"randomised by Pharmaceutical company...using randomisation table"
Allocation concealment (selection bias)	Unclear risk	Method not described
Blinding of participants and personnel (performance bias) All outcomes	Low risk	"titration and trial phases conducted under double blind conditions with double dummy technique"
Blinding of outcome assessment (detection bias) All outcomes	Low risk	"titration and trial phases conducted under double blind conditions with double dummy technique"
Incomplete adverse event outcome data‐ patient level	High risk	AEs reported on fewer than 90% participants
Selective reporting bias for adverse events	High risk	Common AEs only reported as mean scores
Size	High risk	< 50 participants per treatment arm