The effects of oral morphine in "titration phase" of carcinoma pain treatment

The aim of the research was to establish the optimal dosage of oral morphine which would be adequate for pain control, its negative effects, frequency, intensity and the occurrence of breakthrough pain (BTP) in titration phase of severe carcinoma pain. Patients and methods. A prospective study was conducted in the Centre for Palliative Care (hospice) University Clinical Centre Tuzla from September 2009 to March 2010. 35 patients whose severe carcinoma pain was treated by fast acting morphine with initial dosage of 8 mg for 4 hours, were examined. Analgesics, and side effects of morphine therapy were monitored along with intensity, occurrence and the duration of breakthrough pain which was seized by additional salvage doses of orally introduced morphine. Basal dose of oral morphine was increased to 12 mg / 4 hours on the forth or 16 mg / 4 hours on the seventh day, if there had been 2 or more breakthrough pains that required the salvage doses. In the statistics we used the chi(2) test, even T-test and the Wilcox test. The difference was seen to be significant at p < 0.05. Results. Upon the admittance to hospice the pain intensity was 8.23 +/- 1.06 and on the second day of treatment by fast acting morphine it was significantly lower (p < 0.0001). Titrating the regular dose of oral morphine, the dos of 48 mg per day was adequate for treating the pain in 9 patients, 72 mg per day in 20 patients and in 6 patient pain control was established with 96 mg daily dosages. Out of total of 269 breakthrough pains the most (138) were recorded within the first three days of treatment. 88.6 % patients had constipation problems, 94.3% with dryness of the mouth, and drowsiness was most prominent during the three days. Conclusion. Using the fast acting morphine in titration phase, efficient control of carcinoma pain is achieved along with the safety and satisfactory prevention of breakthrough pain. It is necessary to undertake preventive measures for reducing the constipation and dryness of the mouth which would ensure that the benefits of pain treatment is not threatened by the intensity of negative effects.