title: Sustained-release morphine sulfate in the management of pain associated with acquired immune deficiency syndrome.
abstract: Sustained-release morphine (SRM) was studied in patients with acquired immune deficiency syndrome (AIDS)-related chronic pain. Outpatients and inpatients with AIDS-related pain were studied for 3-18 days in an open-label prospective survey. Patients were stratified according to prior opioid analgesic use for the purposes of initiating and titrating SRM, which was administered at a 12-hr interval. Immediate-release morphine (IRM) was offered every 2 hr as needed for supplemental analgesia at one-quarter to one-third of the 12-hourly SRM dose. Pain intensity (PI), quality of life (QL), acceptability of therapy (AT), side effects, safety, and morphine usage were evaluated. Of 44 patients enrolled, 40 (91%) were evaluable for intent-to-treat analysis, and 24 (55%) completed the study. PI decreased by 50% (from severe to mild-moderate) in the intent-to-treat patients and by 65% (from severe to mild) in the completed patients. QL was fair to good in 80% and poor in 20% of both groups. AT was good to excellent in 78% of the intent-to-treat and in 96% of the completed patients. Of 61 adverse events reported, 61% required intervention, and 92% were resolved. Total morphine dose remained stable while IRM dosage and frequency of use significantly decreased with escalation of the SRM dose. A significant reduction in PI was achievable with SRM in a variety of painful conditions experienced by AIDS patients, with limited or manageable side effects in most. This study supports the usefulness of opioid analgesia for severe pain in AIDS.
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, Bronx, New York 10467, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kaplan
authors.forename: M
authors.initials: M
authors.lastname: Conant
authors.forename: D
authors.initials: D
authors.lastname: Cundiff
authors.forename: R
authors.initials: R
authors.lastname: Maciewicz
authors.forename: K
authors.initials: K
authors.lastname: Ries
authors.forename: S
authors.initials: S
authors.lastname: Slagle
authors.forename: J
authors.initials: J
authors.lastname: Slywka
authors.forename: B
authors.initials: B
authors.lastname: Buckley
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D003692:Delayed-Action Preparations; D006801:Humans; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies
chemical_list: D003692:Delayed-Action Preparations; D009020:Morphine