Extended-release, once-daily morphine (Avinza) for the treatment of chronic nonmalignant pain: effect on pain, depressive symptoms, and cognition.
OBJECTIVE
To evaluate the impact of an extended-release, once-daily morphine sulfate formulation on depressive symptoms and neurocognition in patients with chronic nonmalignant pain.


METHODS
Prospective, open-label, one-group trial with a pretest-posttest design.


METHODS
Outpatient pain management clinic.


METHODS
Chronic nonmalignant pain patients inadequately controlled with short-acting opioid analgesics and eligible for treatment with once-daily morphine sulfate were initiated on a dose at or near the morphine-equivalent dose of the short-acting regimen.


RESULTS
The following assessments were made at baseline and 4 weeks after initiating intervention: pain intensity, pain unpleasantness, pain suffering, pain behaviors, Beck Depression Inventory, and cognitive function.


RESULTS
Eighty-four patients provided usable data. Pain intensity, unpleasantness, and suffering scores were significantly reduced at follow-up (P = 0.001). The mean Beck Depression Inventory scores were significantly lower at follow-up (P = 0.001). Significant improvements were seen in scores at follow-up on the three validated neurocognitive tests: the digit span test, the digit symbol substitution test, and the paced auditory serial addition test (P = 0.001).


CONCLUSIONS
Achieving adequate pain control with once-daily morphine was associated with a reduction in pain and improvements in depressive symptoms and cognitive functioning in the short term.
Panjabi
Sumeet S
SS
Elan Pharmaceuticals, Inc., South San Francisco, California, USA. sumeetp@mail.utexas.edu
Panjabi
Ravi S
RS
Shepherd
Marvin D
MD
Lawson
Kenneth A
KA
Johnsrud
Michael
M
Barner
Jamie
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000494:pharmacology / Q000627:therapeutic use; D009483:Neuropsychological Tests; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine