A comparative study of controlled-release morphine (CRM) suspension and CRM tablets in chronic cancer pain

Boureau, F.; Saudubray, F; d'Arnoux, Christine; Vedrenne, J; Estève, Marc; Roquefeuil, B; Siou, D. Kong A; Brunet, René; Ranchère, Jean Yves; Roussel, Philippe; Richard, Anne; Laugner, B.; Müller, André; Donnadieu, S

doi:10.1016/0885-3924(92)90018-d

Cited by 19 publications

(5 citation statements)

References 17 publications

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“…For example, comparing the efficacy and adverse effects of CMR suspension and CMR tablets in 2 groups of adult cancer patients with pain showed no statistically significant differences between the 2 forms of administration in pain or QOL indices 77 . In another study with cancer patients suffering severe pain, epidural morphine was administered in 1 group as a continuous infusion and in another group as intermittent bolus doses.…”

Section: The Effect Of Treatments Of Pain On Qolmentioning

confidence: 99%

Pain and Quality of Life

Niv¹,

Kreitler

2001

Pain Practice

152

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This paper deals with the impact of pain on quality of life (QOL). Two major factors have contributed to the enhanced importance of QOL in recent years: the increasing frequency of pain and the resources devoted to its treatment, and the growing theoretical insight that pain affects the person as a whole. QOL is defined as the person's evaluation of his or her well-being and functioning in different life domains. It is a subjective, phenomenological, multidimensional, dynamic, evaluative, and yet quantifiable, construct. Commonly used scales for its assessment (eg, WHOQOL, SF-36) are described. Studies show that pain affects most domains of QOL, primarily physical and emotional functioning. The effect depends on the extent, duration, acuteness, intensity, affectivity, and meaning of the pain as well as on the underlying disease and the individual's characteristics. QOL is sensitive also to the treatment of pain and treatment modalities, as shown particularly by studies on cancer pain. Pain reduction is not always attended by the expected improvement in QOL. Pain is not synonymous with poor QOL and constitutes only one important factor determining QOL. The main conclusions are that treatment of pain should be multidisciplinary, considering the impact of pain and the treatment on QOL and targetting also improvement of the affected domains of QOL.

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Section: The Effect Of Treatments Of Pain On Qolmentioning

confidence: 99%

Pain and Quality of Life

Niv¹,

Kreitler

2001

Pain Practice

152

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“…Data from prospective studies indicates that chronic nausea is observed in 15% to 30% of patient receiving oral morphine for chronic cancer pain. 9,11,13,[114][115][116][117][118][119][120][121] Symptomatic management. These are no studies to indicate the superiority of one antiemetic over another in the management of opioid-induced nausea.…”

Section: Nausea and Vomitingmentioning

confidence: 99%

“…Data from prospective studies indicates that chronic constipation is observed in 40% to 70% of patient receiving oral morphine for chronic cancer pain. 9,11,13,[114][115][116][117][118][119][120][121] Opioid-induced constipation can be exacerbated by metabolic alterations (diabetes, hypercalcemia, hypokalemia, uremia, hypothyroidism), dehydration, advanced age, reduced physical activity/immobility, low-fluid and/or low-fiber diet intake, difficulty reaching the bathroom, mechanical obstruction, neurologic disorders, autonomic failure, drugs with anticholinergic action such as ondansetron, diuretics, anticonvulsants, iron, vinca alkaloids, and some antihypertensive drugs. 124,125 Symptomatic management.…”

Section: Constipationmentioning

confidence: 99%

Strategies to Manage the Adverse Effects of Oral Morphine: An Evidence-Based Report

Cherny¹,

Ripamonti²,

Pereira³

et al. 2001

JCO

559

307

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Successful pain management with opioids requires that adequate analgesia be achieved without excessive adverse effects. By these criteria, a substantial minority of patients treated with oral morphine (10% to 30%) do not have a successful outcome because of (1) excessive adverse effects, (2) inadequate analgesia, or (3) a combination of both excessive adverse effects along with inadequate analgesia. The management of excessive adverse effects remains a major clinical challenge. Multiple approaches have been described to address this problem. The clinical challenge of selecting the best option is enhanced by the lack of definitive, evidence-based comparative data. Indeed, this aspect of opioid therapeutics has become a focus of substantial controversy. This study presents evidence-based recommendations for clinical-practice formulated by an Expert Working Group of the European Association of Palliative Care (EAPC) Research NETWORK: These recommendations highlight the need for careful evaluation to distinguish between morphine adverse effects from comorbidity, dehydration, or drug interactions, and initial consideration of dose reduction (possibly by the addition of a co analgesic). If side effects persist, the clinician should consider options of symptomatic management of the adverse effect, opioid rotation, or switching route of systemic administration. The approaches are described and guidelines are provided to aid in selecting between therapeutic options.

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“…A few studies have provided limited data on the relationship between opioid-induced side effects and total opioid dose (10,11). While the primary purpose of these studies was not to evaluate the prevalence and severity of analgesic side effects or the relationship between total dose and severity of side effects, some information can be extrapolated from this work.…”

Section: Literature Reviewmentioning

confidence: 99%

“…While the primary purpose of these studies was not to evaluate the prevalence and severity of analgesic side effects or the relationship between total dose and severity of side effects, some information can be extrapolated from this work. Boureau et al (10) compared the efficacy and adverse effects of controlled-release morphine suspension and controlled-release morphine tablets for chronic cancer pain in a crossover study of 44 patients. The prevalence rates for those side effects that persisted throughout the two-week study ranged from 75.8% to 78.8% for constipation, 57.1% to 75.0% for nausea, 50.0% for vomiting, and 69.0% to 86.2% for daytime drowsiness.…”

Section: Literature Reviewmentioning

confidence: 99%

Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

Villars

Dodd

West

et al. 2007

Journal of Pain and Symptom Management

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An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC + PRN opioid); to determine if there were differences in the severity of side effects among the four prescriptions groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of eleven side effects. Significant differences (P < 0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC + PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC + PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC + PRN prescription types and higher doses of opioid analgesics.

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A comparative study of controlled-release morphine (CRM) suspension and CRM tablets in chronic cancer pain

Cited by 19 publications

References 17 publications

Pain and Quality of Life

Pain and Quality of Life

Strategies to Manage the Adverse Effects of Oral Morphine: An Evidence-Based Report

Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

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