title: Pilot study of nasal morphine-chitosan for the relief of breakthrough pain in patients with cancer.
abstract: Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tolerability and efficacy of a novel morphine-chitosan formulation. Twenty episodes of breakthrough pain were observed in 14 patients with cancer who received 5-80 mg of nasal morphine-chitosan. Nasal symptoms, sedation, giddiness, nausea, and other volunteered symptoms, along with pain scores (pain intensity and pain relief), were recorded at baseline and at regular intervals up to 4 hours after administration, together with an overall satisfaction rating. The formulation was acceptable to patients, generally well tolerated, and had an onset of pain relief 5 minutes after dosing. This formulation warrants further study.
authors.affiliation: Hayward House Macmillan Specialist Palliative Care Unit, Nottingham City Hospital NHS Trust, United Kingdom.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pavis
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
authors.forename: Jane
authors.initials: J
authors.lastname: Edgecombe
authors.forename: Diane
authors.initials: D
authors.lastname: Carr
authors.forename: Cathann
authors.initials: C
authors.lastname: Manderson
authors.forename: Ann
authors.initials: A
authors.lastname: Church
authors.forename: Anthony
authors.initials: A
authors.lastname: Fisher
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D002686:Chitin / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D048271:Chitosan; D004359:Drug Therapy, Combination; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010865:Pilot Projects
chemical_list: D000701:Analgesics, Opioid; D006490:Hemostatics; D002686:Chitin; D009020:Morphine; D048271:Chitosan