Controlled-release oxycodone compared with controlled-release morphine in the treatment of cancer pain: a randomized, double-blind, parallel-group study
by
Mucci-LoRusso P, Berman BS, Silberstein PT, Citron ML,
Bressler L, Weinstein SM, Kaiko RF, Buckley BJ, Reder RF.
Harper Hospital and Karmanos Cancer Institute, Detroit, MI, USA.
Eur J Pain. 1998;2(3):239-49

ABSTRACT

Controlled-release oral formulations of oxycodone and morphine are both suitable analgesics for moderate to severe pain. They were compared in cancer-pain patients randomized to double-blind treatment with controlled-release oxycodone ( [Formula: see text] ) or controlled-release morphine ( [Formula: see text] ) every 12 h for up to 12 days. Stable analgesia was achieved by 83% of controlled-release oxycodone and 81% of controlled-release morphine patients in 2 days (median). Following titration to stable analgesia, pain intensity (0=none to 3=severe) decreased from baseline within each group ( [Formula: see text] ), from 1.9 (0.1) to 1.3 (0.1), mean (SE), with controlled-release oxycodone, and from 1.6 (0.1) to 1.0 (0.1) with controlled-release morphine (no significant between-group differences). Typical opioid adverse experiences were reported in both groups. Hallucinations were reported only with controlled-release morphine ( [Formula: see text] ). Visual analog scores (VAS) for 'itchy' and 'scratchin' were lower with controlled-release oxycodone ( [Formula: see text] ), as was peak-to-trough fluctuation in steady-state plasma concentration ( [Formula: see text] ). The correlation between plasma concentration and dose was stronger ( [Formula: see text] ) for oxycodone (0.7) than morphine (0.3). The relationship between pain intensity (VAS) and plasma concentration was more positive for oxycodone ( [Formula: see text] ). There was a positive relationship between morphine-6-glucuronide concentrations and urea nitrogen and creatinine levels ( [Formula: see text] ). Controlled-release oxycodone was as effective as controlled-release morphine in relieving chronic cancer-related pain, and as easily titrated to the individual's need for pain control. While adverse experiences were similar, controlled-release oxycodone was associated with less itching and no hallucinations. Controlled-release oxycodone provides a rational alternative to controlled-release morphine for the management of moderate to severe cancer-related pain.

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