Intravenous morphine for breakthrough (episodic-) pain in an acute palliative care unit: a confirmatory study

Journal of Pain and Symptom Management
Sebastiano MercadanteSalvatore Mangione

Abstract

The aim of this prospective cohort study was to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen for the management of breakthrough pain and to record the nurse compliance on regularly recording data regarding breakthrough pain treated by IV-M. Over a one-year period, 99 patients received IV-M for breakthrough pain during 116 admissions. The IV-M dose was 1/5 of the oral daily dose, converted using an equianalgesic ratio of 1/3 (IV/oral). For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to reassess the patient 15minutes after IV-M injection (T15). Nurses were unaware of the aim of the study and just followed department policy. In total, 945 breakthrough events treated by IV-M were recorded and the mean number of events per patient per admission was eight (95% confidence interval (CI) 6.9-9.5). The mean dose of IV-M was 12mg (95% CI 9-14mg). In the 469 events (49.6%) with a complete assessment, a decrease in pain of more than 33% and 50% was observed in 287 (61.2%) and 115 (24.5%) breakthrough events, respectively. The mean pain intensity decreased from 7.2 (T0) to 2.7 (T15). In e...Continue Reading

References

Jun 1, 1990·Pain·R K Portenoy, N A Hagen
Sep 25, 2002·The American Journal of Hospice & Palliative Care·Paul GlareKristine A Nelson
May 3, 2003·Palliative Medicine·J T HarrisM R Rajagopal
Mar 31, 2004·Journal of Pain and Symptom Management·Sebastiano MercadanteAlessandra Casuccio
Jul 30, 2005·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Sebastiano MercadanteAlessandra Casuccio

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Citations

Oct 1, 2010·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Sebastiano MercadanteEdoardo Arcuri
Apr 9, 2013·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Sebastiano MercadanteAlessandra Casuccio
Jul 26, 2013·Japanese Journal of Clinical Oncology·Takashi YamaguchiUNKNOWN Japanese Society of Palliative Medicine
Apr 16, 2010·The Clinical Journal of Pain·Sebastiano MercadanteAlessandra Casuccio
Apr 28, 2010·Expert Review of Neurotherapeutics·Mellar P Davis
Nov 2, 2014·Expert Review of Clinical Pharmacology·Sebastiano Mercadante
Apr 9, 2009·Expert Opinion on Pharmacotherapy·Alessandra CasuccioFabio Fulfaro
Jul 23, 2013·Current Medical Research and Opinion·Sebastiano MercadanteAlessandra Casuccio
Oct 2, 2012·Current Medical Research and Opinion·Nicholas MooreHélène Schneid
Apr 7, 2012·Current Medical Research and Opinion·Sebastiano MercadanteAlessandra Casuccio
Jan 22, 2015·BMC Medicine·Kenneth R GoldschneiderDanette Stanko-Lopp
Jun 26, 2013·Journal of Pain and Symptom Management·Silvia DeandreaGiovanni Apolone
Jan 11, 2011·Critical Reviews in Oncology/hematology·Sebastiano Mercadante
Sep 21, 2010·Metabolism: Clinical and Experimental·Gérard E Plante, Theodore B VanItallie
May 12, 2009·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Alec B O'ConnorChangyong Feng
Feb 14, 2009·European Journal of Pain : EJP·Sebastiano Mercadante
Aug 12, 2015·Current Opinion in Anaesthesiology·Sebastiano Mercadante
Aug 28, 2016·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Sebastiano Mercadante, Arturo Cuomo
Jul 28, 2016·European Journal of Internal Medicine·Sebastiano Mercadante
Feb 4, 2012·The Lancet Oncology·Augusto CaraceniUNKNOWN European Association for Palliative Care (EAPC)
May 20, 2017·Clinical Journal of Oncology Nursing·Jeannine M BrantThiruppavai Sundaramurthi
May 14, 2020·The Oncologist·Sebastiano Mercadante
Mar 6, 2009·Current Opinion in Supportive and Palliative Care

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