 Evaluating dextromethorphan plus slow-release morphine for chronic cancer pain relief in terminally ill patients This multicenter trial examined the efficacy and safety of dextromethorphan (DM) as an enhancer of analgesia and modulator of opioid tolerance in cancer patients with pain. Sixty-five eligible patients were randomized to slow-release morphine plus DM or slow-release morphine plus placebo. The initial DM dose was 60 mg four times daily for seven days, with an increase to 120 mg four times daily, if tolerated, for another seven days. During the study, patients recorded medications and scores for pain, nausea, drowsiness, and insomnia. The differences in average pain scores, number of breakthrough doses, and change
in total morphine consumption between the DM group and the placebo group were
not statistically significant. Side-effect scores were not statistically significantly
different. Dizziness was greater in the DM (58%) than placebo (36%) group. This
study showed a statistically nonsignificant enhancement of analgesia or modulation
of opioid tolerance in cancer patients with pain when DM was added to morphine.
Participants receiving the DM also had more toxicity, particularly dizziness.
This toxicity and the limited evidence of effect do not support the use of DM
to enhance opioid analgesia or to modulate opioid tolerance in cancer patients.
Dudgeon DJ, Bruera E, Gagnon B, Watanabe SM, Allan SJ, Warr DG, MacDonald SM,
Savage C, Tu D, Pater JL. From J
Pain Symptom Manage. J Pain Symptom Manage. 2007 Apr;33(4):365-71. |
| Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York City ©2005 Continuum Health Partners, Inc. www.stoppain.org/palliative_care |
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