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American Journal of Hospice and Palliative Medicine®
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The efficacy and side effects of continuous infusion intravenous morphine (CIVM) for pain and symptoms due to advanced cancer

Paul Glare, MD, FRACP

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Declan Walsh, MSc, FACP, FRCP (Edin)

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Eileen Groh, MSN

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Kristine A. Nelson, MD

Board of Scientific Counselors, Cancer Treatment Research Foundation, Arlington Heights, Illinois

Morphine is the strong opioid of choice in the management of moderate-to-severe chronic cancer pain. The preferred route of administration is oral, in individually titrated doses, regularly scheduled around the clock. We conducted a retrospective study of continuous intravenous morphine (CIVM) in a palliative medicine program in 107 consecutive patients. The results suggest CIVM is an effective, safe, and versatile method of morphine administration when used with a defined protocol. Efficacy was similar to that obtained by others with intravenous morphine sulfate and also for oral morphine. Safety was suggested by the low incidence of dose-limiting side effects, most of which responded to dose reduction. Particularly noteworthy was the flexibility of CIVM with dose reduction in 20 percent.

Key Words: advanced cancer • cancer patients • continuous infusion • continuous intravenous morphine • morphine sulfate • opioid • pain control • palliative medicine • symptom management

American Journal of Hospice and Palliative Medicine®, Vol. 19, No. 5, 343-350 (2002)
DOI: 10.1177/104990910201900512
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