Mercadante, S., Intravaia, G., Villari, P., Ferrera, P., Riina, S., & Mangione, S. (2008). Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: A confirmatory study. Journal of Pain and Symptom Management, 35, 307–13.

To perform a prospective cohort study to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen to manage breakthrough pain; to record nurse compliance to data-recording regimen regarding treatment with IV-M

In the course of 116 admissions during one year, 99 patients received IV-M for breakthrough pain.

• Of the 99 patients, 53 were male and 46 were female.
• Mean patient age was 62; of all participants, 42% were over 65.

Italy

Prospective cohort study

• The measurement instrument was a tool to measure pain intensity.
• Nurses implemented the measurement method. Nurses documented the number of patients who benefited from IV-M within 15 minutes of administration and the number of patients who needed further treatment after 15 minutes. In addition, nurses documented adverse events severe enough to require medical intervention.

• Mean pain intensity decreased from 7.2 to 2.7 within 15 minutes.
• In all, 945 breakthrough events were treated. The mean number of events/patient/admission was eight. The mean dose of IV-M was 12 mg.
• At the end of the study, nurses had collected complete documentation for 49.6% of events. Of the 49.6%, a decrease in pain of greater than 33% was documented in regard to 61.2% of patients. In 24.5% of patients, documentation showed a pain decrease of greater than 50%.

IV-M given at doses proportional to basal dose provided prompt analgesia and was effective in most cases.