Page 110 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 2

Author: Wiffen PJ A1
Date: 02-12-2008
Question: Should IV morphine PCA vs. IV hydromorphone PCA be used for mucositis pain in children
aged approximately 14 years?
Settings: Children’s hospital, Boston, MA, USA.
Bibliography: Collins J et al. Patient controlled analgesia for mucositis pain in children. A three period
crossover study comparing morphine and hydromorphone. Journal of Pediatrics, 1996, 129:722–728.
A2
Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations IV morphine PCA IV hydromorphone PCA Relative (95% CI) Absolute Quality A3

Efficacy (follow-up: 10–33 days; mean daily pain scores) a
1 Rand- Serious b No Serious c No None 10/10 10/10 No Not LOW
omized serious serious (100%) (100%) differ- pooled
trial incon- impre- ence Not A4 A4
sistency cision
pooled
Adverse events (follow-up: mean 10 days; patient self report)
1 Rand- Serious b No Serious b No None No No No sta- – LOW
omized serious serious data data tistical
trial incon- impre- differ-
sistency cision ence
IV, intravenous; PCA, patient-controlled analgesia; CI, confidence interval. A5
a No statistical difference between mean daily pain scores. Dose potency hydromorphone to morphine estimated at
5.1:1 (usually considered as 7:1).
b Only 10 participants – crossover study. Data extracted as reported.
c Assessed mucositosis pain not cancer pain.

A6

A7

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