Nunes, B.C., Garcia, J.B., & Sakata, R.K. (2014). Morphine as first medication for treatment of cancer pain. Brazilian Journal of Anesthesiology, 64, 236–240. 

DOI Link

Study Purpose

To evaluate the use of morphine as a first-line medication for pain in patients with advanced or metastatic cancer instead of the World Health Organization (WHO) ladder

Intervention Characteristics/Basic Study Process

This was a prospective, randomized study on the effectiveness of morphine as a first-line medication in two groups. The two groups were randomized using envelops. Patients in group 1 (G1) were treated according to the WHO analgesic ladder guidelines with paracetamol at 1 g every six hours (titrated up to a maximum of 4 g per day), codeine at 30 mg every four hours (360 mg per day), and morphine at 10 mg every four hours. Group 2 (G2) received morphine at 10 mg every four hours. G1 patients switched drugs according to pain intensity following the analgesic ladder, and G2 patients had their dose adjusted based on intensity, adjusting the dose of the analgesic drug. All additional adjuvant therapies were logged. Pain intensity was measured every two weeks using the Visual Analog Scale, quality of life and satisfaction with treatment were assessed, and physical capacity was determined by the Eastern Cooperative Oncology Group index.

Sample Characteristics

  • N = 60  
  • AVERAGE AGE = G1 58.7 years (SD = 12.4 years); G2 57.5 years (SD = 12.7 years)    
  • MALES: G1 83.33%; G2 90%, FEMALES: G1 16.67%; G2 10%
  • KEY DISEASE CHARACTERISTICS: No specific disease was targeted although there was a high incidence of head and neck cancer. 

Setting

  • SITE: Single site    
  • SETTING TYPE: Inpatient

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Elder care and palliative care 

Study Design

Retrospective, randomized study

Measurement Instruments/Methods

  • A confidence level of 95% and a study power of 80% were used. This determined that 30 patients per group were needed.
  • In total, 150 patients were screened, and 60 met inclusion criteria.

Results

Twenty-four patients in G1 and 29 in G2 completed the study. There was no difference in patient satisfaction between the groups. There was a higher incidence of adverse effects (i.e., vomiting, nausea, constipation) in G2. This supported what is seen in the literature. These effects were manageable and did not negatively affect quality of life. The study was conducted over three months although the sample was obtained over two years and six months. There were no consistent differences in pain severity between the groups.

Conclusions

This study demonstrated the efficacy of both methods for the reduction of pain intensity in both groups, and that both methods are comparable.

Limitations

  • Small sample (< 100)
  • Other limitations/explanation: Double-blinding was not possible.

Nursing Implications

Morphine as a first-line treatment for patients with advanced and moderate cancer appeared to be acceptable as a treatment for pain. The management of adverse symptoms was manageable and was comparable to traditional therapy.