The use of intravenous morphine for breakthrough pain in terminal cancer patients admitted to hospice center.

Abstract

e20621 Background: The adequate opioid dose to be administered for breakthrough pain(BTP) is still controversial. Dosing recommendations are based on patient’s(pts) total daily opioid dose. Intravenous morphine(IV-M) has been found to be effective and safe for the management of BTP. However, physicians are often reluctant in using large doses of IV-M because of the possible adverse events in terminal cancer pts. The aim of this study was to evaluate whether pts were treated appropriately for their BTP in hospice setting. Methods: A total of 94 consecutive terminal cancer pts who were admitted in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from June 2012 to Nov 2012 were analyzed in this study. Results: In total, 1,213 BTP events treated by IV-M were recorded and the mean number of events per pts was 13.6 (95% confidence interval (CI) 10.5-15.4). The mean dose of IV-M was 13.9mg (95% CI 12.5-14.5mg, range 3-90mg) and was equivalent to 7.1% of the total daily opioid dose. For each episode, pain intensity and opioid-related symptoms were recorded at the base (T0) and within 30 minutes after (T1). Pain intensity decreased from a mean of 5.1(on a 0-10 numeric scale) at base to 1.8 at T1. A decrease in pain of more than 30%, 50% and 70% was observed in 1179 (97.2%), 958 (78.9%) and 460 (37.9%) BTP events, respectively. In 21 episodes, no changes in pain intensity were observed and a further dose of IV-M was given. Doses of more than 10mg, 30mg and 50mg of IV-M were given for 456 (37.6%), 200 (16.5%) and 104(8.6%). No differences in age, sex and pain location were found. Adverse effects were uncommon, moderate nausea/vomiting in 32 episodes, drowsiness in 15 episodes, and confusion in one episode. Conclusions: In the current study, IV-M was safe and effective for almost all episodes of BTP. This study shows that IV-M did not result in life-threatening adverse effects in terminal cancer pts, including older pts and those requiring relatively large doses.