2096P - Morphine titration with intravenous patient-controlled analgesia for severe cancer pain (Mr.TIPS)

Background

The National Comprehensive Cancer Network (NCCN) guideline recommend starting with opioids for severe cancer pain or pain crisis. In this case, short-acting oral opioids or injections can be considered and drug titration should be performed by re-evaluating after 1 hour for oral drugs and after 15 minutes for injections. However, in actual medical practice, it's challenging to promptly administer injections and perform dose titration through pain assessment every 15 minutes. Patient-controlled analgesia (PCA) is a recommended method that enables patients to self-administer medication, potentially reducing the time required for medication administrations, but there are limited studies on this.

Methods

Patients with cancer pain with an average NRS (Numeric Rating Scale) score of 7 or higher within the last 24 hours were enrolled from 3 centers. The patients who were taking opioids with a morphine equivalent daily dose of 300 mg/day or higher were excluded. Patients complete a pain diary at baseline, 1, 2, 4, 12, 24, and 48 hours. The researchers monitor side effects and conduct a brief pain assessment at 24 and 48 hours. Patients also record their Patient Global Impression of Change (PGI-C) at 24 and 48 hours. The endpoint of this study is percentage of patients with a pain NRS score of 3 or less one hour after PCA application.

Results

Between August 2021 and April 2023, a total of 38 patients were enrolled in the study, with 37 completing and 1 dropout. Of these, 8 (21%) were opioid-naive and 29 (76%) were opioid-tolerant. Within 1 hour, 26 patients (68%) reached NRS 3 or lower pain control. And in a 24-hour PGI-C, 26 patients (63%) reported their condition as very much or much improved. The 33 patients (87%) had no adverse events during the study. Four patients experienced side effects, such as nausea and vomiting; three were mild and one was moderate. No serious adverse events (SAEs) were reported. A possible association between the medication and symptoms was observed in two patients, whereas for the other two, it was assessed to be unlikely.

Conclusions

Effective pain management through dose titration is crucial in the treatment of severe cancer pain. The study confirmed that PCA-based pain control was highly effective, safe, and satisfactory for patients.

Clinical trial identification

DAUHIRB-21-125.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

BC.

Disclosure

All authors have declared no conflicts of interest.