Treatment of severe cancer pain by low-dose continuous subcutaneous morphine

Abstract

In a prospective and intraindividually controlled trial, we have compared the efficacy and safety of a continuous subcutaneous morphine infusion with conventional intermittent oral or subcutaneous morphine application. Twenty-eight in-patients with cancer pain received a short-term infusion lasting 2-42 days, and 8 out-patients underwent long-term infusion from 49 to 197 days during the terminal stage of their disease. Continuous subcutaneous morphine infusion significantly (P less than 0.001) improved both pain and quality of life when compared to conventional morphine application. With continuous infusion, 5-48 mg (median 19 mg) of morphine was required daily, significantly (P less than 0.001) less than the 10-90 mg (median 50 mg) necessary with conventional use. As a result of lower dosage, side effects under continuous infusion were infrequent and mild. Constipation occurred in 3 of the 36 patients and was always controlled by the addition of laxatives; no nausea, sedation or respiratory depression were observed. Signs of tolerance developed in 2 patients on long-term infusion, but the use of continuous subcutaneous methadone for 2 weeks reversed the tolerance. The study presented indicates that low-dose continuous subcutaneous morphine provides a valuable treatment modality for severe terminal cancer pain exhibiting a high degree of both efficacy and safety.

A Prospective Population Pharmacokinetic Study on Morphine Metabolism in Cancer Patients

“…For fast titration in cases of severe pain, we mainly use continuous subcutaneous administration. This has been found to be safe and effective [13, 14], has advantages over the intravenous route, and can also be applied safely in an out-of-hospital setting [13, 15]. …”

Constipation – a difficult therapeutic problem

“…W badaniach klinicznych zarówno fentanyl, jak i buprenorfina rzadziej niż morfina powodowały zaparcie, mimo to jest to głów-ne działanie niepożądane tych leków [62][63][64][65][66].…”

When oral morphine fails in cancer pain: The role of the alternative routes

“…1 In patients failing to achieve satisfactory analgesia with oral morphine, subcutaneous morphine may provide effective analgesia with lessened severity of nausea and vomiting. 6,7 Morphine may be given subcutaneously either as bolus injections every four hours or by continuous infusion. A plastic cannula can be inserted easily in the anterior chest or abdomen to avoid multiple injections.…”