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Less nausea, emesis, and constipation comparing hydromorphone and morphine? A prospective open-labeled investigation on cancer pain

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Abstract

Goals of work

The purpose of this trial was to evaluate the effect of long-term treatment with either oral sustained-release hydromorphone (HM) or morphine (M) on nausea, emesis, and constipation.

Materials and methods

In a prospective, open-labeled, controlled trial, 100 outpatients with cancer pain and treatment with HM or M were enrolled. Mobility, pain, and gastrointestinal symptoms were assessed by the ECOG performance status, selected items of the EORTC questionnaire and Numerical Rating Scales (NRS). Data were analyzed using descriptive and confirmatory statistics (paired t-test, chi square test, Poisson regression).

Main results

Demographic and medical data were comparable in both treatment groups. Taking into account different conversion factors, opioid doses (M 94.4 mg/d vs. HM 137.6 [HM/M = 1:5], p = 0.05 and HM 206.4 [HM/M = 1:7.5], p = 0.0002, respectively) were higher under hydromorphone and NRS of pain (M 2.3 vs. HM 3.6, p = 0.0002) lower under morphine. Nausea and emesis did not attenuate in 33% of patients. NRS of nausea (M 2.5 vs. HM 1.5; p = 0.01), incidences of emesis (M 0.7/d vs. HM 0.1/d, p = 0.0001), the consumption of antiemetics (M 26 vs. HM 14, p = 0.01), and the number of constipated patients (M 8 vs. HM 2, p = 0.04) were higher in the morphine group. An extended use of substances for symptom control revealed constipating effects (M 31 vs. HM 13, p = 0.0003) and was associated with a higher incidence of constipation in the morphine group.

Conclusions

Symptom control in outpatients with cancer pain may be complicated by a symptom controlling medication. Particularly, antiemetics revealed potentially constipating effects. Despite lower opioid doses, morphine provided a better pain control but produced more side effects. Comparing hydromorphone with morphine, it remains unclear if fewer incidences of constipation and nausea in the hydromorphone group were related to pharmacodynamic effects or to a less effective pain control with significantly higher NRS for pain. However, the conversion factor of oral hydromorphone and morphine needs to be questioned.

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Acknowledgements

The authors gratefully thank the nurses and patients of the pain clinic of the University of Bonn, Germany for their collaboration and contribution to this work. The help of Marta Diederichs, Annette Dahlhaus, and Kathleen Wolf in organization and performance of the study is especially acknowledged.

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  1. Clinic for Anesthesiology and Intensive Care Medicine, Pain Clinic Department, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany

    S. Wirz, H. C. Wartenberg & J. Nadstawek

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  1. S. Wirz
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  2. H. C. Wartenberg
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Correspondence to S. Wirz.

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Wirz, S., Wartenberg, H.C. & Nadstawek, J. Less nausea, emesis, and constipation comparing hydromorphone and morphine? A prospective open-labeled investigation on cancer pain. Support Care Cancer 16, 999–1009 (2008). https://doi.org/10.1007/s00520-007-0368-y

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