Mercadante, S., Tirelli, W., David, F., Arcara, C., Fulfaro, F., Casuccio, A., & Gebbia, V. (2010). Morphine versus oxycodone in pancreatic cancer pain: A randomized controlled study. The Clinical Journal of Pain, 26(9), 794–797.

To test the hypothesis that oxycodone has advantages over morphine in terms of efficacy and dose escalation in the treatment of pancreatic cancer pain

Patients were randomized to one of two groups: One group took 30 mg/day sustained-release morphine; the other, 20 mg/day sustained-release oxycodone. Clinicians increased doses as needed to treat pain that measured higher than 4 on a 0–10 rating scale or if the patient had more than three episodes of breakthrough pain per day. Patients in both groups used oral morphine, at one-sixth daily dose, to address breakthrough pain. Adjuvants were prescribed at the discretion of the clinician. Investigators collected data for four weeks. Patients could enter an extension phase that lasted eight weeks. Investigators followed patients in inpatient palliative care units, at home, and through outpatient care.

• The sample was composed of 39 patients, of which 17 patients completed the eight-week extension.
• Mean patient age was 63.2 years (SD = 9.48 years).
• Of all patients in the initially randomized group, 58.7% were female and 41.3% were male.
• All patients had pancreatic cancer. The study excluded patients with bone metastases.

• Single site
• Palliative care, home, and outpatient care
• Italy

Randomized controlled trial

• Numeric rating scale (0–10), to measure pain
• Rating scale (0–3), to measure side effects and symptoms

Authors noted no differences between groups in pain intensity or use of breakthrough medication. Pain decreased in both groups, in a similar pattern of decline. Dose escalation was similar in both groups. In regard to use of adjuvant pain medication, authors noted no differences between groups. Side effects were similar across groups, with the exception that patients receiving oxycodone had a greater increase in confusion over the course of eight weeks (p = 0.011). No difference in confusion was apparent between groups at any other time point.

This study revealed no differences in the analgesia and side effects associated with morphine and oxycodone, delivered according to similar dose escalation, used in the treatment of pancreatic cancer pain.

• The study had a small sample, with fewer than 100 patients.
• The study had a risk of bias due to no blinding.

This study suggests that, over an eight-week period, morphine SR and oxycodone SR provide similar analgesia with similar side effects. Whether differences would become apparent during a longer term is unknown.