| It is well known that cancer has been becoming the first reason that causes human death. In many countries, most patients arrive at oncologic treatment center when their disease is in advanced stage, as early diagnosis is very rarely made. Thus it would be better to offer to these incurably ill cancer patients efficient pain relief and a death without unnecessary suffering, rather than highly expensive oncologic therapy , often with high morbidity. Of the 45-50 million deaths per year in the world, 10% are due to cancer: half of these are accompanied by pain in the advanced stages of the disease. In 1982, WHO endorsed the WHO Cancer Control Program, whose objective is to offer pain relief to cancer patients through the existing health care systems. In 1990, a simple well-validated, and effective method for assuring the rational titration of therapy for cancer pain has been devised by WHO. Because of "ceiling effect" of non narcotics (Step I) and weak narcotics (Step II), it is very important to use strongnarcotics (Step III) properly. Strong opioids gained more and more importance with time, and nonopioids was finally useful only in a minority of patients. As we all know, morphine is the representative medicine of narcotics. And morphine sulfate controlled-release tables (MST) is the best one in all kinds of morphine preparations. In our clinical trial, 128 cancer patients who suffered from more than moderate pain were entered in the pain management unit. Purpose To evaluate the efficacy, side effects, addiction, method of dosage titration of morphine sulfate controlled-release tablets following the introduction of the WHO guidelines for the management of cancer pain. Methods 128 patients with chronic, moderate or severe cancer pain were studied. The daily initial dosage of morphine sulfate controlled-release tables (MST) started from 20 mg. Adjuvant drugs could be added at any time necessary. If the pain was not relieved after 1-2 days, the dosage was increased to 30-50% each step. If the pain was relieved after radiotherapy or chemotherapy, the dosage can be decreased to 30-50% stepwise. During the treatment the dosage titration was carried out whenever it is necessary until ceasation of medicine. Details of the patient' s condition, as well as their drugs, side effects, addiction, and reasons for change of therapy, were recorded by the treating physician using a standardized questionnaire. Assessments were performed at time intervals that were variable anddependent on the situation of the patient. Results The total pain relief rate was up to 98. 4%. The mean daily initial dosage , maintenance dosage and maximum dosage were 20mg, 60mg and 90mg respectively. The mean sustained time of taking medicine was 68. 1 days, and the maximum was up to 326 days. About 65 (50. 8%) cases of the patients did not need to increase their daily initial dosage, 63 cases (49.2 %) of patients did. The increment of dosage was 30% to 300% for 55 cases ( 43.0% ) ,300%-500% increment was observed in 5 cases (3.9%), and only 3 cases (2. 3%) the increment was up to 500%. Morphine sulfate controlled-release tables (MST) was effective in relieving all kinds of pain, and no significant difference was noted between visceral pain and bone pain. Among 94 patients who ceased to take the medicine, the reasons of ceasing were dead, relieving due to radiotherapy or chemotherapy, getting worse or adverse reaction. The common side effects were constipation and nausea. No addiction was observed in all patients. Conclusion 1.Morphine sulfate controlled-release tables (MST) should be the first choice in the control of moderate or severe cancer pain. 2.The dosage of morphine sulfate controlled-release tables is based on the patient himself-it is very different in different patients. 3 .Dosage titration of morphine sulfate controlled-release tables is the key to control cancer pain. 4. Morphine sulfate controlled-release tables is very safe and addictionis rare in the treatment of cancer pain .
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