Intravenous morphine for management of cancer pain

In recent years, a growing interest in palliative care and in routes of administration other than oral have prompted more aggressive measures to improve the efficacy of analgesic interventions in patients with difficult pain conditions. This review provides an overview of the use of intravenous morphine to control pain in patients with cancer. Intravenous morphine has been increasingly used in different clinical situations--including breakthrough pain, poor pain control with escalating doses of oral opioids, retitrating patients with acute pain, treating patients with long-standing poor pain control and unpredictable needs, and optimising opioid therapy to prevent incident pain associated with bone metastases. Although intravenous administration requires supervision, it has considerable advantages, since direct administration into the circulation provides a rapid and predictable effect that is independent of absorption problems. I.v. morphine is advantageous in specific clinical situations and should be part of armamentarium of all physicians treating pain in patients with cancer.