Evaluation of the effectiveness of oral morphine for pain control in patients with carcinoma of the cervix at Ocean Road Cancer Institute (ORCI)

Abstract

Morphine is a drug which is grouped in the category of opioids. There are several forms of morphine one being in liquid form which is taken orally. It is used to relieve moderate to severe pain that does not respond to non opioids specifically the NSAID’s. However morphine is highly addictive once used incorrectly can lead into side effects such as constipation, drowsiness, abdominal cramps, excessive sweating and even weight loss. Objective The objective of this study is mainly to investigate the effectiveness of oral morphine in the control of pain in cancer patients specifically patients with carcinoma of the cervix who form the majority of patients attended at ORCI. Also to assess the level of pain of the majority of patients seen at ORCI and the most common side effects of morphine that the patients experience. This will lead to the relationship between level of pain, morphine dosage and the side effects encountered. Methodology The study was conducted at ORCI which is located along Indian Ocean. It is a teaching and referral Hospital and approximately 230 staffs are enrolled. Approximately 5500 cancer patients visit our hospital per year. This is a prospective hospital based cohort study which has been conducted for three months focusing on the patients response to morphine specifically patients who have not shown response to NSAID’s. The patients with carcinoma of the cervix who have been assessed for pain before treatment have been included in the study and whole patients with other gynaecological malignancies and cancer of the cervix patients who have started radiation or chemotherapy have been excluded from the study. Dose titrations after careful pain assessment have been performed as to keep patients free from pain. Data was collected by using structured questionnaires and then analyzed by SPSS version 21 software. The total budget for the study was Tshs 1,560,000.

Findings The research findings among 93 patients investigated (36.6%) were observed to be of age group 50-59 as the majority. (62.4%) were of primary education and among the group (72%) were married and the leading zone was Lake zone covering (27%).The disease stage IIB were mostly seen with (50.5%) of the total studied group. Before morphine administration (54.8%) had moderate pain covering more than half of the population. After morphine administration (80.6%) had no further pain. The commonest side effect was constipation (69.6%), drowsiness (48.9%) and sweating (27.7%) Discussion The above findings are consistent with several studies done worldwide that supports that morphine is effective in control of pain and should be titrated according to patients responsiveness to pain (21,25,30).The study further shows that reducing morphine does not have significance in constipation as it may be caused by other factors like locally advanced disease to the pelvis example rectal involvement.