title: Use of sustained release oral morphine as a bridge in withdrawal of morphine in patients on high doses of oral immediate release morphine for cancer pain.
abstract: According to World Health Organization (WHO), cancer pain can be controlled effectively with oral morphine in up to 90% of patients. Due to advancement in anticancer therapy and early presentation of cancer patients, the likelihood of cure is on an increasing trend. Awareness and education in the use of oral morphine, and easier regulations in procurement of oral morphine for use in cancer pain has lead to prescription of oral morphine to more patients earlier in pain therapy. In many patients, resolution of disease occurs and it becomes necessary to withdraw morphine. Guidance for starting medications is fairly easily obtained, but it is difficult to find information about switching or discontinuing opioids. The initial decrease in dose is well tolerated by the patient but the last few steps of complete withdrawal are difficult. We present 2 cases where the sustained release oral morphine was used as a bridge to withdraw immediate release oral morphine successfully in 2 patients after resolution of disease.
authors.affiliation: Unit of Anaesthesiology, Pain and Palliative Care, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arif
authors.initials: A
authors.lastname: Ahmed
authors.forename: Himanshu
authors.initials: H
authors.lastname: Khurana
authors.forename: Vikas
authors.initials: V
authors.lastname: Gogia
authors.forename: Seema
authors.initials: S
authors.lastname: Mishra
authors.forename: Sushma
authors.initials: S
authors.lastname: Bhatnagar
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000150:complications / Q000628:therapy; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control*; D014062:Tongue Neoplasms / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D009020:Morphine