VIENNA, AustriaCancer pain patients with chronic renal failure
are more likely than others to need changes in their morphine
regimen, reported M. Escher, MD, of the Multidisciplinary Pain
Center, University Hospital, Geneva, Switzerland. This retrospective
study, reported at the 9th World Congress on Pain, reviewed medical
records of 110 cancer patients who had been referred for a pain
consultation and had been prescribed morphine.
Dr. Escher reported that 48% of patients required some type of
adjustment to their morphine regimen, either a dosage change or
change to another opioid (25% of patients were switched to a
Adverse effects were the major reason for treatment adjustment and
accounted for 53% of changes (Table).
In 24% of cases, the treatment change was a reduction in morphine
dose because pain was adequately controlled at lower doses. One
interesting fact Dr. Escher reported is that a substantial number of
patients (11%) refused to take morphine, thus necessitating a change
in the treatment regimen.
Adverse events occurred in 37% of the total patient population.
However, in about one third of these patients, no treatment
adjustment was needed. The most common side effects in patients
requiring treatment adjustment were nausea/ vomiting and sedation.
Dr. Escher found that patients with chronic renal failure (defined as
creatinine greater than 101µmol/L or creatinine clearance less
than 50 µL/min) were significantly more likely than those
patients with normal renal function to need treatment adjustments (P
There were no significant differences in need for treatment
adjustments relative to type of pain (nociceptive, mixed, or neuropathic).
Chronic renal failure is the major factor associated with a
therapeutic adjustment of morphine, Dr. Escher concluded.
Adverse effects are the main, but not the only, reason for adjustment.
He concluded that morphine prescription needs individuation,
and opi-oid rotation is an option to be considered when faced with
some of these problems.