Clinical Observation Of Initial Dose Titration Of Controlled-release Oxycodone And Morphine Tablets On The Outpatients With Moderate To Severe Cancer Pain

Objective: To explore the efficacy,the adverse events and the improvement of life quality of controlled-release oxycodone(CR oxycodone)combined with morphine tablets during the dose titration in outpatients with moderate to severe cancer pain.Methods : Among the cancer pain patients receiving treatment in the pain clinic of the first hospital affiliated to China Medical University from June 2016 to June 2017,60 patients with moderate or severe cancer pain(NRS greater than 4)were selected,all of whom were opioid intolerant patients,with KPS score of 40 or more.They were divided into group A and group B according to the random number table,with 30 patients in each group.Group A: controlled-release oxycodone combined with morphine hydrochloride tablets were used for treatment.The initial dose of controlled-release oxycodone was10 mg,and each 12 h was taken orally.Group B: morphine hydrochloride tablets were administered with a starting dose of 5mg and taken orally every 4h.Both groups experienced moderate or greater pain 1 hour after the first administration or during the two times of regular administration,which could be remedied with morphine hydrochloride tablets.The remedial dose in group A was half of the single dose of oxycodone on that day.The remedial dose in group B was equivalent to the single dose of morphine.Doses were adjusted every 24 hours according to the analgesia and adverse reactions of the patients.Simultaneously prescribe of oral ondansetron 4mg,QD,to prevent nausea and vomiting.Oral forlax(polyethylene glycol powder)10g,1~2 times/d,to prevent constipation.Patients were followed daily for NRS score,number of eruption pain,time of sleep and adverse reactions.Results: 1.NRS scores: after the treatment,the NRS scores of the two groups all decreased.The pain relief rates of the group A at day 1,2,3 and 7 were respectively73.3%,80.0%,90.0% and 96.7%.The pain relief rates of the group B at day 1,2,3 and 7were respectively 53.3%,63.3%,83.3% and 93.3%.2.Changes in the frequency of outbreak of pain: The frequency of outbreak of pain within 3 days after treatment in group A was significantly lower than that in group B,and the difference was statistically significant(P < 0.01),while there was no significantdifference in two groups 3 days later(P>0.05).3.Changes in sleep time: The average sleep time of patients in group A and group B prolonged from 4.0h 、 4.1h to 6.5h and 6.0h respectively,with no statistically significant difference(P>0.05).4.Adverse reaction incidence: Commonly reported adverse events were nausea and vomiting 5 cases(16.7%)in group A and 4 cases(13.3%)in group B;constipation 6cases(20%)in group A and 5 cases(16.7%)in group B;anorexia 3(10%)in group A and4 cases(13.3%)in group B;dizziness 2 cases(6.7%)in group A and none in group B;urinary retention 2 cases(6.7%)in both groups;skin itching none in A group and 2cases(6.7%)in group B.No serious adverse events took place.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions: Medicationgs of both groups can safely and effectively relieve moderate to severe pain of cancer patients.The combination group achieved better pain relief rate,faster reaching titration concentration,effectively reducing the frequency of outbreak of pain,effectively improving the sleep of patients,and the incidence of adverse reactions was not significantly increased.