A retrospective study of the association between haematological and biochemical parameters and morphine intolerance in patients with cancer pain.
BACKGROUND
Morphine is the strong opioid of choice for the treatment of moderate to severe cancer pain according to guidelines of the World Health Organization (WHO). However, a minority of patients do not receive the desired analgesic effect or suffer intolerable side effects from morphine, and are switched to alternative opioids.


METHODS
The aim of this retrospective study was to identify factors that might be associated with morphine intolerance. Data were analysed from 100 controls who tolerated morphine and 77 patients who were switched to an alternative opioid. We investigated whether currently logged data could fully explain the need to switch. Demographic details, cancer type (histological diagnosis) and markers related to organ function were included in an analysis of biochemical and haematological parameters.


RESULTS
Patients over 78 years (P = 0.03), or with a high white cell (P = 0.002) or high platelet count (P = 0.003), were more likely to switch. Although our numbers were small, patients with severe organ impairment were more likely to switch. However, a model including white cell count, platelet count, age, serum albumin and alkaline phosphatase, accurately separated switchers and controls in only 68% of cases. There was no significant difference between the two groups in terms of the numbers of patients having cytotoxic drugs in the two weeks prior to the haematological and biochemical analysis. Similarly, there were no significant differences in histological diagnoses between groups.


CONCLUSIONS
The white cell count was the strongest single effect observed and, as such, warrants further investigation. Further studies are needed in order to accurately define a model that will predict those patients likely to be intolerant of morphine.
Department of Palliative Medicine, Royal Marsden Hospital, London, UK. julia.riley@rmh.nthames.nhs.uk
J
J
Riley
J R
JR
Ross
D
D
Rutter
S
S
Shah
B
B
Gwilliam
A U
AU
Wells
K
K
Welsh
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000704:Analysis of Variance; D016022:Case-Control Studies; D002908:Chronic Disease; D006402:Hematologic Diseases / Q000139:chemically induced*; D006801:Humans; D007962:Leukocytes / Q000187:drug effects; D009020:Morphine / Q000009:adverse effects*; D009369:Neoplasms / Q000150:complications*; D010148:Intractable Pain / Q000188:drug therapy*; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D009020:Morphine