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Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management.
Eur J Pain. 2008 Nov; 12(8):1040-6.EJ

Abstract

PURPOSE

The aim of this study was to compare the analgesic and adverse effects, doses, as well as cost of opioid drugs, supportive drug therapy and other analgesic drugs in patients treated with oral sustained-release morphine, transdermal fentanyl, and oral methadone.

PATIENTS AND METHODS

One hundred and eight cancer patients, no longer responsive to opioids for moderate pain, were selected to randomly receive initial daily doses of 60 mg of oral sustained-release morphine, 15 mg of oral methadone, or 0.6 mg (25 microg/h) of transdermal fentanyl. Oral morphine was used as breakthrough pain medication during opioid titration. Opioid doses, pain intensity, adverse effects, symptomatic drugs, were recorded at week intervals for 4 weeks. Costs of opioid therapy, supportive drugs, and other analgesic drugs were also evaluated.

RESULTS

Seventy patients completed the 4 weeks period of study. Five, five, and four patients, treated with oral morphine, transdermal fentanyl, and oral methadone, respectively, required opioid switching. No differences in pain and symptom intensity were observed. Opioid escalation index was significantly lower in patients receiving methadone (p<0.0001), although requiring up and down changes in doses. At the doses used, methadone was significantly less expensive (p<0.0001), while the use and costs of supportive drugs and other analgesics were similar in the three groups. No relevant differences in adverse effects were observed among the groups during either the titration phase and chronic treatment.

CONCLUSION

All the three opioids used as first-line therapy were effective, well tolerated, and required similar amounts of symptomatic drugs or co-analgesics. Methadone was significantly less expensive, but required more changes, up and down, of the doses, suggesting that dose titration of this drug requires major clinical expertise.

Authors+Show Affiliations

Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@lamaddalenanet.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

18353696

Citation

Mercadante, Sebastiano, et al. "Sustained-release Oral Morphine Versus Transdermal Fentanyl and Oral Methadone in Cancer Pain Management." European Journal of Pain (London, England), vol. 12, no. 8, 2008, pp. 1040-6.
Mercadante S, Porzio G, Ferrera P, et al. Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. Eur J Pain. 2008;12(8):1040-6.
Mercadante, S., Porzio, G., Ferrera, P., Fulfaro, F., Aielli, F., Verna, L., Villari, P., Ficorella, C., Gebbia, V., Riina, S., Casuccio, A., & Mangione, S. (2008). Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. European Journal of Pain (London, England), 12(8), 1040-6. https://doi.org/10.1016/j.ejpain.2008.01.013
Mercadante S, et al. Sustained-release Oral Morphine Versus Transdermal Fentanyl and Oral Methadone in Cancer Pain Management. Eur J Pain. 2008;12(8):1040-6. PubMed PMID: 18353696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. AU - Mercadante,Sebastiano, AU - Porzio,Giampiero, AU - Ferrera,Patrizia, AU - Fulfaro,Fabio, AU - Aielli,Federica, AU - Verna,Lucilla, AU - Villari,Patrizia, AU - Ficorella,Corrado, AU - Gebbia,Vittorio, AU - Riina,Salvatore, AU - Casuccio,Alessandra, AU - Mangione,Salvatore, Y1 - 2008/03/18/ PY - 2007/08/22/received PY - 2008/01/28/revised PY - 2008/01/28/accepted PY - 2008/3/21/pubmed PY - 2008/10/31/medline PY - 2008/3/21/entrez SP - 1040 EP - 6 JF - European journal of pain (London, England) JO - Eur J Pain VL - 12 IS - 8 N2 - PURPOSE: The aim of this study was to compare the analgesic and adverse effects, doses, as well as cost of opioid drugs, supportive drug therapy and other analgesic drugs in patients treated with oral sustained-release morphine, transdermal fentanyl, and oral methadone. PATIENTS AND METHODS: One hundred and eight cancer patients, no longer responsive to opioids for moderate pain, were selected to randomly receive initial daily doses of 60 mg of oral sustained-release morphine, 15 mg of oral methadone, or 0.6 mg (25 microg/h) of transdermal fentanyl. Oral morphine was used as breakthrough pain medication during opioid titration. Opioid doses, pain intensity, adverse effects, symptomatic drugs, were recorded at week intervals for 4 weeks. Costs of opioid therapy, supportive drugs, and other analgesic drugs were also evaluated. RESULTS: Seventy patients completed the 4 weeks period of study. Five, five, and four patients, treated with oral morphine, transdermal fentanyl, and oral methadone, respectively, required opioid switching. No differences in pain and symptom intensity were observed. Opioid escalation index was significantly lower in patients receiving methadone (p<0.0001), although requiring up and down changes in doses. At the doses used, methadone was significantly less expensive (p<0.0001), while the use and costs of supportive drugs and other analgesics were similar in the three groups. No relevant differences in adverse effects were observed among the groups during either the titration phase and chronic treatment. CONCLUSION: All the three opioids used as first-line therapy were effective, well tolerated, and required similar amounts of symptomatic drugs or co-analgesics. Methadone was significantly less expensive, but required more changes, up and down, of the doses, suggesting that dose titration of this drug requires major clinical expertise. SN - 1532-2149 UR - https://www.unboundmedicine.com/medline/citation/18353696/Sustained_release_oral_morphine_versus_transdermal_fentanyl_and_oral_methadone_in_cancer_pain_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1090-3801(08)00022-0 DB - PRIME DP - Unbound Medicine ER -