Constipation and Oral Opioid Therapy with Morphine or Hydromorphone: are there Differences?
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Wirz, S, University of Bonn, Clinic of Anaesthesiology, Germany, Wartenberg, HC, University of Bonn, Clinic of Anaesthesiology, Germany, Wittmann, M, University of Bonn, Clinic of Anaesthesiology, Germany, Elsen, C, University of Bonn, Clinic of Anaesthesiology, Germany, Nadstawek, J, University of Bonn, Clinic of Anaesthesiology, Germany
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Introduction: Aim of this investigation was the assessment of the symptom constipation in cancer pain patients with either with oral morphine or oral hydromorphone.
Methods and patients: After ethical approval of the local ethics committee and patients written consent we enrolled 70 cancer pain patients (morphine group/MG) or oral hydromorphone (hydromorphone group/HMG) into this prospective comparative and observational study. We assessed the symptom constipation by the criteria stool free interval, defecation rate, a Numerical Rating Scale of the subjective feeling of being constipated (NRS constipation) for a period of five consecutive days.
Results: Mean age was 57.5 (HMG) resp. 60.4 years (HMG). Cancer diagnoses were lung cancer (MG 40%, 14% HMG) and urogenital tumours (MG 30%, HMG 30%), and gastro-intestinal cancers (HMG 24%). Mean daily dosage of morphine was 100.6 mg (sd9/74.8), and of hydromorphone was 27.5 mg (sd9/23.4). Mean NRS for pain was 3.4 (MG) resp. 3.6 (HMG). Defecation rate were 0.94 per day (MG) and 0.9 (HMG). The stool free interval>three days (15% MG-4% HMG) and NRS for constipation differed (3.94 MG-HMG 2.2). Patients used laxatives, and patients. Laxative use (80% MG, 70% HMG) comprised polyethylene glycol (HMG 40%, MG 65%), sodium-picosulphate (HMG 24%, MG 25%), mostly.
Conclusion: Constipation signs were more frequent in patients with an morphine therapy. In comparison with morphine hydromorphone seems to have less constipating effects.
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