Clinical Drug Investigation

, Volume 29, Supplement 1, pp 17–23 | Cite as

Standard Therapy with Opioids in Chronic Pain Management

  • Antonio Gatti
  • Carlo Reale
  • Roberto Occhioni
  • Marta Luzi
  • Alessandra Canneti
  • Claudia De Polo
  • Martina Gubernari
  • Massimo Mammucari
  • Alessandro Fabrizio Sabato
Original Research Article Part 1: Pain Management in the Clinical Setting


Objective: Moderate to severe pain is commonly experienced by cancer and non-cancer patients. Although opioids are generally the most important drugs in chronic pain management, their use in Italy remains low. We designed a prospective open trial to assess the efficacy and safety of a standard therapy clinically available for a large range of patients.

Methods: A total of 172 consecutive patients (89 women and 83 men) with chronic pain (daily mean visual analogue scale (VAS) score > 4) that was not adequately managed by their existing pain regimen were enrolled to receive an immediate release (IR) dose of morphine: 30 mg/day (opioid-naive patients) or 60 mg/day (non-naive patients) for 5 days. After this period (start therapy), all patients were switched to slow release (SR) opioid therapy for 30 days (steady therapy). Each breakthrough pain (BTP) episode was treated with a single dose of IR morphine (20% of the daily dose) during all study periods.

Results: Daily VAS score was reduced from 7.4 ± 1.3 at baseline to 3.8 ± 1.5 (p < 0.0001) after 30 days of steady therapy in cancer and non-cancer patients. Fewer patients reported BTP events by study end (55% of patients with BTP at basal time had no BTP at last follow up), and the number of daily BTP events experienced by patients was reduced by therapy to 1–2 per day in 75% of patients reporting BTP. Further, the time delay to reach pain relief following administration of a rescue dose of IR morphine was 15 minutes or less in 52.1% of patients at study end. The standard therapy was well tolerated and fewer adverse effects were recorded at the end of the study period compared with baseline, with the exception of constipation, which showed a moderate increase (from 18.2% to 25.0%).

Conclusion: Start therapy with IR morphine followed by conversion to SR opioid therapy could be implemented as a standard therapy to manage moderate to severe chronic pain in patients with cancer or non-cancer pain. ORamorph® in TIBER study (ORTIBER).



This study received no external funding, and the authors have no potential conflicts of interest that are directly relevant. English language assistance for the preparation of this manuscript was provided by Rod McNab, Wolters Kluwer Health Medical Communications. This assistance was funded by Molteni Farmaceutici, Inc. The authors thank Ennio Sarli for data analysis.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Antonio Gatti
    • 1
  • Carlo Reale
    • 2
  • Roberto Occhioni
    • 3
  • Marta Luzi
    • 2
  • Alessandra Canneti
    • 2
  • Claudia De Polo
    • 1
  • Martina Gubernari
    • 1
  • Massimo Mammucari
    • 4
  • Alessandro Fabrizio Sabato
    • 1
  1. 1.Anaesthesiology and Intensive Care Medicine DepartmentUniversity of Tor VergataRomeItaly
  2. 2.University “La Sapienza”Institute of Anaesthesiology, Resuscitation and Pain TherapyRomeItaly
  3. 3.Anaesthesiology DepartmentAzienda Ospedaliera S. Camillo-ForlaniniRomeItaly
  4. 4.Medical Advisor of Anaesthesiology and Intensive Care Medicine DepartmentUniversity of Tor VergataRomeItaly

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