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Starting Step III opioids for moderate to severe pain in cancer patients:
Dose titration: A systematic review

Palliative Medicine
25(5) 424–430
! The Author(s) 2010
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216310386280 pmj.sagepub.com ˚
Pal Klepstad Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Intensive Care, St Olavs University Hospital, Trondheim, Norway
Stein Kaasa Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway; Department of Palliative Care, St Olavs University Hospital, Trondheim, Norway
Petter C Borchgrevink Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian
University of Science and Technology (NTNU), Trondheim, Norway; Center for Pain and Complex Disorders, St. Olav University Hospital, Trondheim, Norway

The European Association for Palliative Care recommendation for starting morphine for cancer pain is dose titration with immediate release (IR) oral morphine given every 4 h with additionally doses for breakthrough pain. As part of a EU
6th framework programme to revise the guidelines we review the evidence regarding starting treatment and dose titration of opioids in adult patients with moderate to severe cancer pain. Relevant papers were identified though a systematic search in Medline for papers published until the end of 2009. We identified 15 relevant papers. Thirteen papers were descriptive papers reporting the results from starting treatment with oral morphine (six studies), starting treatment with intravenous morphine (two…...

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