Safety and Efficacy Study of Hydromorphone and Morphine
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 21 - 65 |
| Updated: | 8/17/2018 |
| Start Date: | October 2004 |
| End Date: | January 2005 |
Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine in Acute, Severe Pain: A Randomized Clinical Trial
To compare a standard weight-based dose of intravenous (IV) hydromorphone (Dilaudid) to a
standard weight-based dose of IV morphine in adults presenting to the Emergency Department
(ED) with acute severe pain.
standard weight-based dose of IV morphine in adults presenting to the Emergency Department
(ED) with acute severe pain.
There is widespread agreement that pain is under-treated in the Emergency Department (ED).
The current recommended treatment of acute pain in the ED setting is administration of an
initial bolus of morphine followed by titration until adequate analgesia is achieved. Several
studies have shown that even 0.1 mg/kg IV morphine (7-10 mg administered to the average
70-100 kg patient) inadequately treats many patients' acute pain. In spite of this, it has
been observed that many emergency physicians and nurses are hesitant to give 7-10 mg of
morphine as an initial IV dose. In contrast, it has been observed that these same healthcare
providers were not similarly reluctant to administer a roughly equianalgesic dose of
hydromorphone (1-1.5 mg), perhaps because the more potent hydromorphone is given in much
smaller milligram quantities than morphine, thus providing the illusion of substantially less
opioid administered to the patient. Having repeatedly observed this phenomenon, it is
reasonable that if a smaller milligram dose of hydromorphone were shown to provide an
efficacy, safety, and side-effect profile comparable or superior to a larger milligram dose
of morphine, it would provide evidence supporting use of hydromorphone as an alternative
first line opioid in the treatment of acute pain presenting to the ED. As a practical
corollary to this, it is reasoned further that the increased willingness of healthcare
providers to use hydromorphone might contribute to reducing one component of the multifaceted
problem of oligoanalgesia in the ED.
The current recommended treatment of acute pain in the ED setting is administration of an
initial bolus of morphine followed by titration until adequate analgesia is achieved. Several
studies have shown that even 0.1 mg/kg IV morphine (7-10 mg administered to the average
70-100 kg patient) inadequately treats many patients' acute pain. In spite of this, it has
been observed that many emergency physicians and nurses are hesitant to give 7-10 mg of
morphine as an initial IV dose. In contrast, it has been observed that these same healthcare
providers were not similarly reluctant to administer a roughly equianalgesic dose of
hydromorphone (1-1.5 mg), perhaps because the more potent hydromorphone is given in much
smaller milligram quantities than morphine, thus providing the illusion of substantially less
opioid administered to the patient. Having repeatedly observed this phenomenon, it is
reasonable that if a smaller milligram dose of hydromorphone were shown to provide an
efficacy, safety, and side-effect profile comparable or superior to a larger milligram dose
of morphine, it would provide evidence supporting use of hydromorphone as an alternative
first line opioid in the treatment of acute pain presenting to the ED. As a practical
corollary to this, it is reasoned further that the increased willingness of healthcare
providers to use hydromorphone might contribute to reducing one component of the multifaceted
problem of oligoanalgesia in the ED.
Inclusion Criteria:
- adults between the ages of 21 and 65 who presented to the ED with acute pain (defined
as pain less than 7 days in duration) (23) of sufficient severity in the judgment of
the ED attending to warrant use of IV opioids.
Exclusion Criteria:
- previous allergy to morphine or hydromorphone
- systolic blood pressure less than 90 mmHg
- alcohol intoxication as judged by the attending physician
- use of other opioids within the past 7 days
- use of an Monoamine Oxidase (MAO) inhibitor
- chronic pain syndromes (such as sickle cell disease or fibromyalgia)
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Montefiore Medical Center As the academic medical center and University Hospital for Albert Einstein College...
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