Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study

Overview

Journal Adv J Emerg Med

Specialty Emergency Medicine

Date 2019 Aug 15

PMID 31410400

Authors

Saeed Majidinejad

Mahdi Ebrahimi

Farhad Heydari

Mahdi Ahmadpour

Mehrdad Esmailian

Affiliations

Soon will be listed here.

Abstract

Introduction: Recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy.

Objective: This study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients.

Method: This double-blind, randomized controlled study conducted between April and September 2017. Ninety eligible cancer patients presenting to Sayed al-Shohada Hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. Pain severity was scored by Visual Analog Scale (VAS). Patients were followed up for 3 days and then data were analyzed by SPSS. The benchmark of success was set as marking 4 or below on VAS and a reduction ratio of 50 percent.

Results: Pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6-10) at baseline to 2.46 (range 1-4) at the end of the 3 day in the nebulized group. The decrease ratio was equal to 70.8% after three days (p<0.05). Pain severity reduced from 8.45 (range 7-10) to 1.8 (range 1-3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6-10) to 2.13 (range 1-3) in the fentanyl group.

Conclusion: Our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer.

References

Menahem S, Shvartzman P . High-dose fentanyl patch for cancer pain. J Am Board Fam Pract. 2004; 17(5):388-90. DOI: 10.3122/jabfm.17.5.388. View

Bruera E, Sala R, Spruyt O, Palmer J, Zhang T, Willey J . Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage. 2005; 29(6):613-8. DOI: 10.1016/j.jpainsymman.2004.08.016. View

Fulda G, Giberson F, Fagraeus L . A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain. J Trauma. 2005; 59(2):383-8. DOI: 10.1097/01.ta.0000179452.70520.1b. View

Lasheen W, Panneerselvam A, Davis M . Can we really say that nebulized morphine works?. J Pain Symptom Manage. 2006; 32(2):101-2. DOI: 10.1016/j.jpainsymman.2006.03.006. View

Clemens K, Klaschik E . Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study. Jpn J Clin Oncol. 2007; 37(4):302-9. DOI: 10.1093/jjco/hym017. View

Mercadante S, Porzio G, Ferrera P, Fulfaro F, Aielli F, Verna L . Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. Eur J Pain. 2008; 12(8):1040-6. DOI: 10.1016/j.ejpain.2008.01.013. View

Pergolizzi J, Boger R, Budd K, Dahan A, Erdine S, Hans G . Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl,.... Pain Pract. 2008; 8(4):287-313. DOI: 10.1111/j.1533-2500.2008.00204.x. View

Fisch M, Lee J, Weiss M, Wagner L, Chang V, Cella D . Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol. 2012; 30(16):1980-8. PMC: 3383175. DOI: 10.1200/JCO.2011.39.2381. View

Modesto-Lowe V, Girard L, Chaplin M . Cancer pain in the opioid-addicted patient: can we treat it right?. J Opioid Manag. 2012; 8(3):167-75. DOI: 10.5055/jom.2012.0113. View

10.

Venkat A, Kim D . Ethical Tensions in the Pain Management of an End-Stage Cancer Patient with Evidence of Opioid Medication Diversion. HEC Forum. 2014; 28(2):95-101. DOI: 10.1007/s10730-014-9257-1. View

11.

Afsharimani B, Kindl K, Good P, Hardy J . Pharmacological options for the management of refractory cancer pain-what is the evidence?. Support Care Cancer. 2015; 23(5):1473-81. DOI: 10.1007/s00520-015-2678-9. View

12.

Grissa M, Boubaker H, Zorgati A, Beltaief K, Zhani W, Msolli M . Efficacy and safety of nebulized morphine given at 2 different doses compared to IV titrated morphine in trauma pain. Am J Emerg Med. 2015; 33(11):1557-61. DOI: 10.1016/j.ajem.2015.06.014. View

13.

Dowell D, Haegerich T, Chou R . CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. 2016; 315(15):1624-45. PMC: 6390846. DOI: 10.1001/jama.2016.1464. View