Effects of morphine: A Synthesis of Findings from 16 Studies

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Original Abstract of the Article

Major Research Findings

Morphine is a widely used opioid for pain management, but it has many side effects. Methadone is an alternative to morphine for the treatment of cancer pain. These papers present research findings comparing morphine and methadone. 6 found that methadone had a lower rate of opioid escalation than morphine. Furthermore, many patients in the methadone group maintained the same initial dosage until death, while only one patient in the morphine group did not require opioid dose escalation. A more stable analgesia over time was shown in patients treated with methadone by the low number of gaps in EASs reported. Symptom frequencies and intensities were similar in the two groups. 11 found that methadone had a higher opioid-related dropout rate than morphine, but it did not show inferior analgesic efficacy or overall tolerability compared to morphine as a first-line strong opioid for the treatment of cancer pain. 13 showed the effectiveness of naloxone to reduce pruritus induced by epidural morphine. 3 compared subjective, physiological, and behavioral effects of morphine, pentazocine, and ciramadol. All three drugs decreased respiratory rate and pupil diameter and increased blood pressure. However, morphine, ciramadol, and pentazocine had different profiles on subjective effect measures. These drugs increased "liking," "good effects," "any effects," and "high" subjective effect scales. Pentazocine increased subjective "bad effects" scale scores and scales measuring dysphoria and sedation. Observers reported significant behavioral changes after administration of morphine and pentazocine, but not after ciramadol. Overall, the effects of morphine (7.5, 15, and 30 mg) and pentazocine (22.5, 45, and 90 mg) were dose-related. Although pentazocine produced increases in scales that indicated negative subjective effects, it also produced significant changes in most self-report measures that were increased by morphine, including liking and good effects scales. The effects of ciramadol were not dose-related, with all three doses (30, 60, and 120 mg) producing effects approximately equivalent to morphine 15 mg. Thus, ciramadol exhibited a ceiling effect typical of the opioid agonist/antagonist. 15 found the effectiveness of ketamine to prevent postoperative pain. 12 evaluated the analgesic and sedative effects of morphine using EEG measures. 16 assessed the influence of ultra-low doses of opioid antagonists on the analgesic properties of opioids and their side effects. 1 evaluated the pharmacology and abuse potential of nalmefene. 10 quantified the effects of morphine-6-glucuronide and morphine on pain threshold, pain tolerance, pupil diameter, and side effects. 9 modeled the drug action of heroin and morphine. investigated the effects of IV morphine on central pain syndromes. 7 retrospectively analyzed sex differences in morphine responses in humans. 4 characterized subjective, psychomotor, and physiological effects of morphine in healthy volunteers. 14 assessed the analgesic efficacy and safety of oral naltrexone in addition to chronic intrathecal morphine infusions in patients with chronic nonmalignant pain. 2 evaluated the analgesic, mood, and side effects of the combination of intramuscular morphine and oral cocaine in patients with postoperative pain and chronic malignant pain.

Benefits and Risks

Benefits Summary

Morphine is a widely used opioid for pain management. 6 , 11 found that morphine is effective in reducing cancer pain. Morphine is also effective in preventing postoperative pain. 15 Methadone is an alternative to morphine for the treatment of cancer pain. 6 found that methadone has a lower rate of opioid escalation than morphine. Furthermore, methadone has shown to have longer-lasting effects than morphine.

Risks Summary

Morphine can cause side effects such as constipation, nausea, vomiting, and drowsiness. 11 , 13 , Methadone has shown to have a higher opioid-related dropout rate than morphine. 11 Methadone is considered to have a higher potential to cause respiratory depression than morphine.

Comparison Between Studies

Similarities

Many of these papers conducted research on humans about the analgesic effects and side effects of opioids like morphine and methadone. These studies considered factors such as opioid dosage, administration method, pain type, and pain intensity. These studies also evaluated the effects of opioids using subjective patient pain ratings and physiological indicators. These studies found that morphine was effective in reducing cancer pain, but it could cause side effects such as constipation, nausea, vomiting, and drowsiness. Methadone was found to be a possible alternative to morphine for the treatment of cancer pain. Methadone had a lower rate of opioid escalation but also had a higher opioid-related dropout rate.

Differences

These papers have different research subjects, research designs, and evaluation items. For example, 6 is a randomized controlled trial comparing methadone and morphine for cancer pain management. On the other hand, 13 is a randomized controlled trial evaluating the effect of naloxone on pruritus induced by epidural morphine. These studies have obtained different results due to their different purposes and research designs.

Consistency and Contradictions in the Results

The results of these studies suggest that morphine is effective in reducing cancer pain, and methadone can be used as an alternative to morphine for the treatment of cancer pain. However, these studies show a higher opioid-related dropout rate for methadone. These studies also suggest that factors such as opioid dosage, administration method, pain type, and pain intensity may affect the effects of opioids. Therefore, these research findings cannot be generalized.

Notes on Application to Daily Life

Opioids such as morphine and methadone are effective drugs for pain relief, but they can cause side effects. It is important to use these medications correctly and under the guidance of a doctor. Furthermore, there are some things to keep in mind when using these medications. For example, morphine can cause constipation, so it is important to drink enough water and eat a diet rich in dietary fiber. Also, morphine can cause respiratory depression, so driving or operating machinery should be avoided. Methadone is considered to have a higher potential to cause respiratory depression than morphine. Therefore, special care is needed when using methadone.

Limitations of Current Research

All of these studies were conducted on humans, but the sample size is small, and the results may not be generalizable. These studies used subjective patient pain ratings and physiological indicators to evaluate the effects of opioids, but these indicators may not always be objective assessments. Therefore, care is needed when interpreting these research results.

Future Research Directions

Based on these research results, future research needs to be conducted on larger samples of humans. Furthermore, the development of more objective indicators to evaluate the effects of opioids is necessary. In addition, the development of new treatments to reduce the side effects of opioids is required.

Conclusion

Morphine is a widely used opioid for cancer pain management. Methadone is an alternative to morphine for the treatment of cancer pain. These papers presented research findings comparing morphine and methadone. These results suggest that morphine is effective in reducing cancer pain, and methadone can be used as an alternative to morphine for the treatment of cancer pain. However, these studies showed a higher opioid-related dropout rate for methadone. These studies also suggest that factors such as opioid dosage, administration method, pain type, and pain intensity may affect the effects of opioids. Therefore, these research findings cannot be generalized. Opioids such as morphine and methadone are effective drugs for pain relief, but they can cause side effects. It is important to use these medications correctly and under the guidance of a doctor.

Literature analysis of 16 papers
Positive Content
10
Neutral Content
3
Negative Content
3
Article Type
16
0
0
0
16
1.

Human pharmacology and abuse potential of nalmefene.

Author: FudalaP J, HeishmanS J, HenningfieldJ E, JohnsonR E

No abuse potential
Agitation/irritability
Muscle tension

Nalmefene did not produce morphine-like effects in six male volunteers with opiate abuse history, demonstrating no abuse potential.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Cocaine and morphine interaction in acute and chronic cancer pain.

Author: KaikoRobert F, KannerRonald, FoleyKathleen M, WallensteinStanley L, CanelAnne Marie, RogersAda G, HoudeRaymond W

Mood improvement
Morphine-like side effects

Cocaine was not found to be an effective analgesic in 36 patients with postoperative or chronic malignant pain, and did not enhance the analgesic effects of morphine.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

3.

Comparative evaluation of morphine, pentazocine and ciramadol in postaddicts.

Author: PrestonK L, BigelowG E, LiebsonI A

Increase liking
Reduce respiratory rate
Dysphoria
Sedation

This study compared the effects of morphine, pentazocine, and ciramadol (an opioid agonist/antagonist) in non-dependent opioid abusers. Morphine and pentazocine produced similar effects, with dose-related increases in pleasant sensations. Pentazocine also produced unpleasant effects. Ciramadol produced effects similar to a lower dose of morphine and did not increase unpleasant effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

4.

A dose-response analysis of the subjective, psychomotor and physiological effects of intravenous morphine in healthy volunteers.

Author: ZacnyJ P, LichtorJ L, FlemmingD, CoalsonD W, ThompsonW K

Psychomotor Impairment

In a study of 12 healthy volunteers, morphine was found to increase feelings of stimulation, high, sedation, spaced out, and drunken. Morphine also impaired reaction time, digit symbol substitution, and Maddox wing, but not eye-hand coordination.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Sex-related differences in the influence of morphine on ventilatory control in humans.

Author: DahanA, SartonE, TeppemaL, OlievierC

Respiratory depression

Morphine affects ventilatory control differently in men and women, suggesting sex-specific effects on the respiratory system.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

6.

Morphine versus methadone in the pain treatment of advanced-cancer patients followed up at home.

Author: MercadanteS, CasuccioA, AgnelloA, SerrettaR, CalderoneL, BarresiL

Analgesic effect
Stable analgesia

Methadone was effective in managing cancer pain and required less dose escalation than morphine, leading to more stable analgesia. Both drugs were well-tolerated, with similar symptom frequencies and intensities.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

7.

Morphine responses in humans: a retrospective analysis of sex differences.

Author: ZacnyJ P

Pain relief
Sex-related differences

There is increasing evidence that sex modulates the effects of opioid analgesics in nonhumans, but few studies have examined this issue in humans. Females reported higher ratings of 'coasting (spaced out),' 'heavy or sluggish feeling' and 'dry mouth.' No differences in degree of psychomotor impairment or physiological effects (miosis and respiration rate) of morphine emerged between males and females.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

8.

Effects of IV morphine in central pain: a randomized placebo-controlled study.

Author: AttalN, GuirimandF, BrasseurL, GaudeV, ChauvinM, BouhassiraD

Pain relief
Reduced allodynia
Limited long-term benefit

Intravenous morphine can reduce brush-induced allodynia in patients with central pain syndromes, but it has little effect on other types of pain. Only a small percentage of patients benefit from long-term opioid treatment.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Time series modeling of heroin and morphine drug action.

Author: TschacherWolfgang, HaemmigRobert, JacobshagenNina

Opioid dependence

Clinical observations suggested different acceptance of morphine and heroin by intravenous drug users in opiate maintenance programs. This study aimed to examine the perceived effects of these drugs, including desired and adverse effects, to understand the reason for this preference.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Analgesic effects of morphine and morphine-6-glucuronide in a transcutaneous electrical pain model in healthy volunteers.

Author: SkarkeCarsten, DarimontJutta, SchmidtHelmut, GeisslingerGerd, LötschJörn

Analgesia

Morphine-6-glucuronide clearly produced analgesic effects, but the high amounts of systemic morphine-6-glucuronide needed to produce the same effects as morphine suggest that morphine-6-glucuronide barely contributes to the central nervous opioid effects after administration of analgesic doses of morphine.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

11.

Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.

Author: BrueraEduardo, PalmerJ Lynn, BosnjakSnezana, RicoMaria Antonieta, MoyanoJairo, SweeneyCatherine, StrasserFlorian, WilleyJie, BertolinoMariela, MathiasClarissa, SpruytOdette, FischMichael J

Cancer pain relief
Global benefit
Opioid-related dropouts

Methadone did not provide superior analgesic efficacy or tolerability compared to morphine for first-line treatment of cancer pain. Both treatments resulted in similar pain reduction and global benefit, but methadone had a higher rate of opioid-related drop-outs.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Dissociation of morphine analgesia and sedation evaluated by EEG measures in healthy volunteers.

Author: QuanteMarkus, SchareinEkehard, ZimmermannRoger, Langer-BrauburgerBirgit, BrommBurkhard

Analgesic effects
Sedation

A study is investigating the analgesic and sedative effects of morphine using an experimental pain model. The study aims to quantify and electrophysiologically evaluate the effects of morphine on pain and sedation.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

13.

Effects of epidural naloxone on pruritus induced by epidural morphine: a randomized controlled trial.

Author: JeonY, HwangJ, KangJ, HanS, RheeK, OhY

Reduced pruritus severity

Continuous epidural infusion of naloxone combined with morphine is effective in reducing the incidence and severity of pruritus induced by epidural morphine.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

14.

Oral naltrexone to enhance analgesia in patients receiving continuous intrathecal morphine for chronic pain: a randomized, double-blind, prospective pilot study.

Author: HamannScott, SloanPaul

Pain relief

Low doses of oral naltrexone, when combined with chronic intrathecal morphine infusions, were effective in reducing pain in patients with chronic nonmalignant pain. Naltrexone was well tolerated in this pilot study.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

[Administration of ketamine during induction and maintenance of anaesthesia in postoperative pain prevention].

Author: ColombaniS, KabbaniY, Mathoulin-PélissierS, GékièreJ-P, DixmériasF, MonninD, LakdjaF

Pain management
Morphine side effects

Carcinologic breast surgery causes moderate postoperative pain and requires 30% more morphine. This study discusses the potential benefits of ketamine as an R-NMDA antagonist, administered peri-operatively, to reduce morphine use and its adverse effects.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : French

16.

Does adding low doses of oral naltrexone to morphine alter the subsequent opioid requirements and side effects in trauma patients?

Author: FarahmandShervin, AhmadiOmid, DehpourAhmadreza, KhashayarPatricia

Reduced nausea

Ultra-low-dose naltrexone combined with morphine does not alter opioid requirements in patients with extremity trauma but may reduce the risk of nausea.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

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