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abstract/original
Purpose The WHO
guidelines on cancer pain management recommend a sequential three-step
analgesic ladder. However, conclusive data
are lacking as to whether moderate pain should
be treated with either step II weak opioids or low-dose step III strong
opioids.
Patients and Methods
In a multicenter, 28-day, open-label randomized controlled study, adults
with moderate cancer pain were assigned to receive
either a weak opioid or low-dose morphine. The
primary outcome was the number of responder patients, defined as
patients with
a 20% reduction in pain intensity on the
numerical rating scale.
Results A total of 240
patients with cancer (118 in the low-dose morphine and 122 in the
weak-opioid group) were included in the
study. The primary outcome occurred in 88.2% of
the low-dose morphine and in 57.7% of the weak-opioid group (odds risk,
6.18;
95% CI, 3.12 to 12.24; P < .001).
The percentage of responder patients was higher in the low-dose morphine
group, as early as at 1 week. Clinically
meaningful (≥ 30%) and highly meaningful (≥ 50%)
pain reduction from baseline was significantly higher in the low-dose
morphine
group (P < .001). A change in the
assigned treatment occurred more frequently in the weak-opioid group,
because of inadequate analgesia.
The general condition of patients, which was
based on the Edmonton Symptom Assessment System overall symptom score,
was better
in the morphine group. Adverse effects were
similar in both groups.
Conclusion In patients with cancer and moderate pain, low-dose morphine reduced pain intensity significantly compared with weak opioids,
with a similarly good tolerability and an earlier effect.
Original article:
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