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The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during ‘titration phase’ in patients with cancer pain

Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute, Milano

C Ripamonti

Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute, Milano

E Fagnoni

Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute, Milano

C Brunelli

Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute, Milano

M Luzzani

IST Istituto Naz.le ricerca sul Cancro S.C. Riabilitazione e Terapia Antalgica e Cure Palliative, Genova

M Maltoni

Ospedale civile di Forlimpopoli Dip. Oncologico Unità Cure Palliative Hospice, Forlì

E Arcuri

Istituto Regina Elena, UOC Rianimazione Terapia Intensiva Terapia del Dolore e Cure Palliative, Roma

O Bertetto

Ospedale Le Molinette, Torino

on behalf of MERITO Study Group

Adequate and rapid pain control is one of the main goals of cancer pain treatment. The objective of this study was to assess the effect and tolerability of oral normal-release morphine during the initial phase of treatment in patients with moderate-to-severe cancer pain. Consecutive patients naïve to strong opioids received normal-release morphine 5 or 10 mg every 4 h during the titration phase (first 5 days), depending on previous analgesic therapy. Pain intensity was assessed using an 11-point Numerical Rating Scale (0–10), and data were recorded in a patient-compiled diary. The primary endpoint was the proportion of time with pain control (a reduction of at least 50% with respect to the baseline pain score) during the titration phase. A total of 159 consecutive patients (102 men; mean age 65 years) with cancer-related pain were enrolled. Pain control was observed for 75% (95% CI 70–80) of the follow-up period in the intent-to-treat population. Overall, 50% and 75% of patients achieved pain control within 8 and 24 h after starting normal-release morphine therapy respectively. The mean pain score was 7.63 points at baseline, and decreased to 2.43 and 1.67 points (both P < 0.001) at days 3 and 5 respectively. The most commonly reported adverse events were somnolence (24% of patients), constipation (22%), vomiting (13%), nausea (10%) and confusion (7%). Normal-release morphine results in rapid and satisfactory pain control, and is well tolerated, during the strong-opioid titration phase in patients with moderate-to-severe cancer pain.

Key Words: cancer pain • morphine • normal release • oral • tolerability

Palliative Medicine, Vol. 22, No. 3, 214-221 (2008)
DOI: 10.1177/0269216308088692


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