| BACKGROUND:Pain is the most common clinical symptoms of the cancer victims. As the incidence rate of cancer is increasing, the number of the patient with cancer pain is increasing. Cancer pain is the most importance factor that influence the QoL of the cancer patients. As the extension of the standardized treatment of cancer pain and the widely used of opioids, the control rate of cancer pain is improving. The control rate of the developed country has reached70-80%.With the reason of the low level medical science and inadequacy cognition of opioids, the medical use of opioids is influenced, so the control rate of the Cancer pain of the developing country is still at a low level. Recent years, the use of the opioids has been reconstructed, with the widely use of the sustained release preparation of opioids, the treatment of cancer pain has gained a good achievement, especially for the mild and moderate cancer pain, but severe cancer pain couldn’t be controlled quickly by the sustained release preparation of opioids, some patients still have to suffer the pain for a long time at the beginning of the treatment. As the Department of Health paied close attention to cancer pain, the use of the immediate release preparation of opioids is spreading gradually. At the beginning of the treatment, the use of the immediate release preparation of opioids elevate the plasma level of opioids quickly, shorten the duration of pain.OBJECTIVE:To explore the fast efficacy and safety of intravenous injection and oral administration of morphine in the treatment of severe cancer pain.METHERLAILS AND METHODS:we enrolled35patients with clinical stages Ⅲ-Ⅳ cancer, they were randomly assigned into two groups, the Ⅳ groups was enrolled19patients and the oral groups16.We used morphine hydrochloride tablets in the oral group, the initial dose was5-10mg, the subsequent dose was administered every1hour according to NRS, until NRS was3or below. After the first agent, NRS must be evaluated every15minutes. If NRS was larger than or equal to7, and the degree of pain was without relieve or even aggravating, then increase the dosage by50-100%, if the pain moderate, administered the same dosage every1hour, until NRS was3or below. If NRS was still larger than or equal to7after4-5cycles(4-5hours) of the titration, the pain should be assessed again, then restart the titration or change the treatment plan. The assessment of NRS is every60minutes when the NRS was equal to or below3, then the administration of morphine was according to the need of the patient, delivered another dose when NRS was larger than3, and the dosage was5mg or lOmg according to the dosage of the last time, the course of the titration continued24h.We used Morphine hydrochloride injection in the Ⅳ groups, the initial does was2-3mg,the subsequent dose was administered every15minutes according to NRS, until NRS was3or below. After the first administration of Morphine, NRS must be evaluated every15minutes. if NRS was larger than or equal to7, and the degree of pain was without relieve or even aggravating, then increase the dosage by50-100%at the next15minutes, if the pain moderate, administered the same dosage every15minutes, until NRS was3or below. If NRS was still larger than or equal to7after4-5cycles (60-75minutes) of titration. the pain should be assessed again, then restart the titration or change the treatment plan. The assessment of NRS is every60minutes when the NRS was equal to or below3, then the administration of morphine was according to the need of the patient, delivered another dose when NRS was larger than3, and the dosage was equal to the dosage of the last time, if the last dosage was lager the5mg, we used5mg.The course of the titration continued24h.RESULTS:The onset time of the oral group was30minutes,and was15minutes in the Ⅳ group.60minutes after the titration, nearly all of the cancer pain was controlled in the IV group, though the oral group needed150minutes. When compare with each other, the P value<0.05in the first2.5hours of the treatment. There was no statistical difference (P>0.05) between the two groups after2.5h. The time needs to control the pain, the oral group was92.81±32.50minutes, the Ⅳ groups was36.32±11.53, the efficacy of the Ⅳ group is higher. The dosage of Morphine used until the pain was controlled, the Ⅳ group was7.15±2.50mg, and the oral group was21.25±6.45mg. When the dosage of Morphine used until the pain was controlled in Ⅳ group was equipotent switched with a calculate ratio of1:3to oral dosage, No difference (P=0.92) was seen between the dosage needed in the two groups, The dosage of Morphine used in both group is commensurable until the pain was controlled in each groups. But during the whole titration, the Ⅳ groups used more morphine than the oral group (P<0.05).The adverse effects:5patients(31.25%) encounter dizziness and5patients (31.25%) feel nausea and vomit in the oral group, when the Ⅳ group was5patients(26.32%) and7patients(36.84%), no significant variation in two groups was observed. There was one patient who encountered urinary retention in the Ⅳ group but none in the oral group. No life-threatening adverse effects such as respiratory depression and sleepiness were seen during the titration in two groups. CONCLUSIONS:To titration severe cancer pain by oral or IV morphine is effective, the efficacy is rapid and the adverse drug reactions are negligible. The efficacy of the IV group is rapider than the oral group, it’s more suitable for severe cancer pain. |
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