Abstract
Purpose
Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation.
Methods
This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects.
Results
34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29 mg vs 4.64 ± 1.28 mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49).
Conclusion
Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Code availability
IBM SPSS 24.0 software for Windows (SPSS, Inc., Chicago, IL, USA).
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Funding
The work was supported by Funding of Harbin Scientific-Technology Bureau (2016RAQXJ213) and Heilongjiang Postdoctoral Research Developmental Funding (LBH-Q14214).
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Authors and Affiliations
Contributions
Protocol design, and manuscript writing: Huichao Zou; clinical practice: Lei Teng, Liuyuan Zhao, Hongxue Shao, Shiyan Lin, Wenhui Zhang; statistical analysis of data and manuscript.
review: Junzhu Dai.
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The protocol was approved by the Institutional Review Board of Harbin Medical University Cancer Hospital. Written informed consent for participation was obtained from patients.
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All authors have read this manuscript and would like to have it considered exclusively for publication in Supportive Care in Cancer.
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The authors declare no competing interests.
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Teng, L., Dai, J., Shao, H. et al. Gabapentin enhances the antinociceptive effect of intrathecal morphine in refractory cancer pain patients. Support Care Cancer 29, 7611–7616 (2021). https://doi.org/10.1007/s00520-021-06350-2
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DOI: https://doi.org/10.1007/s00520-021-06350-2