title: Administration of morphine sulfate extended-release capsules via gastrostomy: dissolution study and case reports.
abstract: BACKGROUND
  Patients with head and neck cancer undergoing radiation treatment develop painful mouth sores described as mucositis. There are grades I-IV of mucositis increasing in severity with grading. The aim of this study was to target patients who had painful mucositis at grade III-IV and treat their radiation-induced mucositis with gastrostomy administered morphine in an extended-release dosing form.
  
  
  OBJECTIVE
  This study is important because many patients have breaks in radiation therapy secondary to severe painful mucositis and thus disrupt their potentially curative radiation treatment.
  
  
  METHODS
  The subjects were patients in a radiation clinic undergoing radiation for various head and neck cancers that had grade III-IV mucositis that was diagnosed by the clinician at the practice. The subjects were screened for mouth pain and sores when they came for radiation and they were then referred for study. The aim of the study was to measure the ability of the patient to administer the contents of the morphine extended-release capsules via gastrostomy tube was evaluated and the pain scores using a numerical rating scale (NRS).
  
  
  METHODS
  The patients were seen in radiation oncology and screened for grade III or IV mucositis and then sent to the pain and palliative care clinic.
  
  
  METHODS
  The measurements were to evaluate the feasibility of the patient's ability to administer the contents of the morphine extended-release capsule into the gastrostomy tube and to measure pain related to radiation-induced mucositis. The results were favorable in that the patients could self-administer the morphine using the described alternate route of administration and the pain scores reflected a trend toward pain relief by gastrostomy tube morphine delivery. However, a larger study sample will need to be investigated to determine efficacy in this type of delivery system for cancer pain relief in this population of patients undergoing radiation treatment for head and neck cancers.
authors.affiliation: Department of Pain Medicine and Palliative Care, Metropolitan Hospital Center, New York, New York 10019, USA. lauren.shaiova@nychhc.org
authors.forename: Lauren
authors.initials: L
authors.lastname: Shaiova
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.forename: Keith
authors.initials: K
authors.lastname: Anderson
authors.forename: Gordon
authors.initials: G
authors.lastname: Loewen
authors.forename: Richard
authors.initials: R
authors.lastname: Ghalie
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: Russell
authors.initials: R
authors.lastname: Portenoy
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D005240:Feasibility Studies; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D052016:Mucositis / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care; D010865:Pilot Projects; D011878:Radiotherapy / Q000009:adverse effects*; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D009020:Morphine