Skip to main content

Advertisement

SpringerLink
Log in

Long-term low-dose morphine for patients with moderate cancer pain is predominant factor effecting clinically meaningful pain reduction

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Patients with cancer often experience pain that affects their daily activities and quality of life. The analgesic ladder recommended by the World Health Organization has proved insufficient for many, and its scientific basis has been questioned. This retrospective study investigated factors related to adherence to long-term opioid therapy for patients with moderate cancer pain, including an evaluation of low-dose morphine relative to tramadol.

Methods

Clinical data were collected of patients with moderate cancer pain (n = 353) who received either low-dose morphine or tramadol and were followed for ≥ 27 weeks. Factors related to regime adherence were investigated, including the analgesia type, cancer therapy (antitumor therapy or palliative care), pain type (nociceptive, neuropathic, or mixed), and living distance to the hospital. Factors related to clinically meaningful pain reduction (≥ 30% reduction in pain from baseline) were also investigated.

Results

Patients taking tramadol, receiving antitumor therapy, experiencing neuropathic pain, and living far from the hospital were more likely to change analgesic strategy compared with, respectively, patients receiving low-dose morphine, palliative care, experiencing nociceptive pain, and living nearby. Factors that increased the likelihood of adherence to the analgesic regime were also associated with the likelihood of clinically meaningful pain reduction. Among adverse effects, a significantly higher percentage of patients experienced constipation in the tramadol group compared with those given morphine.

Conclusions

Among patients with moderate cancer pain, long-term low-dose morphine was safe and more effective than tramadol for clinically meaningful pain reduction, and patients were less likely to change the analgesic strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. WHO Expert Committee (1990) Cancer pain relief and palliative care. World Health Organ Tech Rep Ser 804:1–75

    Google Scholar 

  2. DeAndrea S, Monatanari M, Moja L et al (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991

    Article  CAS  Google Scholar 

  3. Mercadante S, Fulfaro F (2005) World Health Organization guidelines for cancer pain: a reappraisal. Ann Oncol 16:iv132–iv135

    Article  Google Scholar 

  4. Ferreira KASL, Kimura M, Teixeira MJ (2006) The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer 14:1086–1093

    Article  Google Scholar 

  5. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, de Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G, European Palliative Care Research Collaborative (EPCRC), European Association for Palliative Care (EAPC) (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13:e58–e68

    Article  CAS  Google Scholar 

  6. Maltoni M, Scarpi E, Modonesi C, Passardi A, Calpona S, Turriziani A, Speranza R, Tassinari D, Magnani P, Saccani D, Montanari L, Roudnas B, Amadori D, Fabbri L, Nanni O, Raulli P, Poggi B, Fochessati F, Giannunzio D, Barbagallo ML, Minnotti V, Betti M, Giordani S, Piazza E, Scapaticci R, Ferrario S (2005) A validation study of the WHO analgesic ladder: a two-step cf. three-step strategy. Support Care Cancer 13:888–894

    Article  Google Scholar 

  7. Marinangeli F, Ciccozzi A, Leonardis M, Aloisio L, Mazzei A, Paladini A, Porzio G, Marchetti P, Varrassi G (2004) Use of strong opioids in advanced cancer pain: a randomized trial. J Pain Symptom Manag 27:409–416

    Article  CAS  Google Scholar 

  8. Sloman R, Wruble AW, Rosen G, Rom M (2006) Determination of clinically meaningful levels of pain reduction in patients experiencing acute postoperative pain. Pain Management Nursing 7(4):153–158

    Article  Google Scholar 

  9. Häuser W, Bock F, Engeser P, Tölle T, Willweber-Strumpfe A, Petzke F (2014) Long-term opioid use in non-cancer pain. Dtsch Arztebl Int 111(43):732–740

    PubMed  PubMed Central  Google Scholar 

  10. Grond S, Radbruch L, Meuser T, Loick G, Sabatowski R, Lehmann KA (1999) High-dose tramadol in comparison to low-dose morphine for cancer pain relief. J Pain Symptom Manag 18:174–179

    Article  CAS  Google Scholar 

  11. Kim HJ, Kim YS, Park SH (2015) Opioid rotation compared with combination for cancer patients with chronic uncontrolled pain: a randomized study. BMC Palliative Care 14(1):1–6

    Article  Google Scholar 

  12. Moksnes K, Kaasa S, Paulsen Ø, Rosland JH, Spigset O, Dale O (2012) Serum concentrations of opioids when comparing two switching strategies to methadone for cancer pain. Eur J Clin Pharmacol 68(8):1147–1156

    Article  CAS  Google Scholar 

  13. Santiago-Palma J, Khojainova N, Kornick C, Fischberg DJ, Primavera LH, Payne R, Manfredi P (2001) Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl. Cancer 92(7):1919–1925

    Article  CAS  Google Scholar 

  14. Eisemberg E, Berkey CS, Carr DB et al (1994) Efficacy and safety of nonsteroidal antiinflammatory drugs for cancer pain: a meta-analysis. J Clin Oncol 12:2756–2765

    Article  Google Scholar 

  15. Minotti V, de Angelis V, Rigetti E et al (1998) Double blind evaluation of short-term analgesic efficacy of orally administered diclofenac, diclofenac plus codeine, and diclofenac plus imipramine in chronic cancer pain. Pain 74:133–137

    Article  CAS  Google Scholar 

  16. Lowery AE, Greenberg MA, Foster SL, Clark K, Casden DR, Loscalzo M, Bardwell WA (2012) Validation of a needs-based biospychosocial distress instrument for cancer patients. Psychooncology 21:1099–1106

    Article  Google Scholar 

  17. Xuemei L, Huaiqing L, Hengjiang G (2002) Epidural patient control using tramadol compared with morphine for postoperative cancer pain. Mod Med Health 18:122–123

    Google Scholar 

  18. Bandieri E, Romero M, Ripamonti CI, Artioli F, Sichetti D, Fanizza C, Santini D, Cavanna L, Melotti B, Conte PF, Roila F, Cascinu S, Bruera E, Tognoni G, Luppi M, the Early Strong Opioid Treatment Study Investigators (2016) Randomized trial of low-dose morphine compared with weak opioids in moderate cancer pain. J Clin Oncol 34(5):436–442

    Article  CAS  Google Scholar 

  19. Seow H, Bainbridge D (2018) A review of the essential components of quality palliative care in the home. J Palliat Med 21(S1):S37–S44

    Article  Google Scholar 

  20. Oh SY, Shin SW, Koh SJ et al (2017) Multicenter, cross-sectional observational study of the impact of neuropathic pain on quality of life in cancer patients. Support Care Cancer 25(12):1–9

    Article  Google Scholar 

  21. Holtzman AL, Williams JP, Hutchinson DF et al (2017) Improving patient-reported pain during radiotherapy through nurse involvement and patient education. J Clin Oncol. https://doi.org/10.1097/COC.0000000000000415

    Article  Google Scholar 

  22. Lampl C, Schweiger C, Haider B, Lechner A (2010) Pregabalin as mono- or add-on therapy for patients with refractory chronic neuropathic pain: a post-marketing prescription-event monitoring study. J Neurol 257(8):1265–1273

    Article  Google Scholar 

Download references

Funding

This work was funded by Science & Technology Department of Sichuan Province grant 2012SZ0143.

Author information

Author notes

  1. Yan Fu contributed equally to this work.

Authors and Affiliations

  1. Thoracic Oncology Department of West China Hospital and Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu, 610041, People’s Republic of China

    Ru-jun Zheng

  2. Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China

    Yan Fu, Jiang Zhu, Qiu-fen Xiang, Hua Zhong, Jun-ying Li & Chun-hua Yu

  3. Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu, 610041, People’s Republic of China

    Jiu-ping Xu

  4. Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China

    Lin Chen

Authors
  1. Ru-jun Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiu-ping Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qiu-fen Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hua Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun-ying Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chun-hua Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jun-ying Li or Chun-hua Yu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, Rj., Fu, Y., Zhu, J. et al. Long-term low-dose morphine for patients with moderate cancer pain is predominant factor effecting clinically meaningful pain reduction. Support Care Cancer 26, 4115–4120 (2018). https://doi.org/10.1007/s00520-018-4282-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4282-2

Keywords

Search

Navigation