title: Morphine as first medication for treatment of cancer pain.
abstract: OBJECTIVE
  the medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder.
  
  
  METHODS
  sixty patients without opioid therapy, with ≥18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months.
  
  
  RESULTS
  the groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p=0.0088), drowsiness (p=0.0005), constipation (p=0.0071) and dizziness (p=0.0376) in the second visit and drowsiness (p=0.05) in the third.
  
  
  CONCLUSIONS
  the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Nunes
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: João Batista dos Santos
authors.initials: JB
authors.lastname: Garcia
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address: riokoks.dcir@epm.br.
authors.forename: Rioko Kimiko
authors.initials: RK
authors.lastname: Sakata
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Analgesia; Cancer pain; Dor oncológica; Morfina; Morphine