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No pain relief from morphine?

Individual variation in sensitivity to morphine and the need to switch to an alternative opioid in cancer patients

Supportive Care in Cancer volume 14, pages 56–64 (2006)Cite this article

Abstract

Goals of work

The aims of this study were (1) to prospectively evaluate the clinical benefits of switching from morphine to an alternative opioid, using oxycodone as first-line alternative opioid, in patients with cancer, (2) to evaluate the consistency of the clinical decision for the need to switch by comparing two hospital sites, and (3) to evaluate whether there were objective predictors that would help identify morphine non-responders who require switching to an alternative opioid and from this to construct a clinical model to predict the need to switch.

Patients and methods

One hundred eighty-six palliative care patients were prospectively recruited from two hospital sites. Responders were patients treated with morphine for more than 4 weeks with good analgesia and minimal side effects. Non-responders (switchers) were patients who had either uncontrolled pain or unacceptable side effects on morphine and therefore required an alternative opioid. The differentiation between responders and switchers was made clinically and later confirmed by objective parameters.

Results

In this prospective study 74% (138/186) had a good response to morphine (responders). One patient was lost to follow up. Twenty-five percent (47/186) did not respond to morphine. These non-responders were switched to alternative opioids (switchers). Furthermore, of 186 patients, 37 achieved a successful outcome when switched to oxycodone and an additional 4 were well controlled when switched to more than one alternative opioid. Overall successful pain control with minimal side effects was achieved in 96% (179/186) of patients. There were no significant differences in the need to switch between the two hospital sites.

Conclusions

This study has shown that proactive clinical identification and management of patients that require opioid switching is reproducible in different clinical settings and significantly improves pain control. Further studies are required to develop and test the predictive model.

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Acknowledgements

This study was supported by the Paul Hamlyn Foundation and the Edmund J. Safra Philanthropic Foundation.

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Authors and Affiliations

  1. Department of Palliative Care, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK

    Julia Riley, Joy R. Ross, Dag Rutter & Katherine Goller

  2. Department of Clinical Genomics, Imperial College, Manresa Road, London, SW3 6LR, UK

    Joy R. Ross, Dag Rutter & Ken Welsh

  3. Faculty of Medicine, National Heart and Lung Institute, Emmanuel Kaye Building, The Royal Brompton Campus, Manresa Road, London, SW3 6LR, UK

    Athol U. Wells & Ron du Bois

  4. The Royal Marsden Hospital, 369 Fulham Road, London, SW3 6JJ, UK

    Julia Riley

Authors
  1. Julia Riley
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  2. Joy R. Ross
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  3. Dag Rutter
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  4. Athol U. Wells
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  5. Katherine Goller
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  6. Ron du Bois
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  7. Ken Welsh
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Correspondence to Julia Riley.

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Riley, J., Ross, J.R., Rutter, D. et al. No pain relief from morphine?. Support Care Cancer 14, 56–64 (2006). https://doi.org/10.1007/s00520-005-0843-2

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  • DOI: https://doi.org/10.1007/s00520-005-0843-2

Keywords

  • Cancer pain
  • Morphine
  • Switching
  • Alternative opioids
  • Oxycodone