Page 119 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 10

Author: Wiffen PJ
Date: 17-04-2009
Question: Should oral morphine be used for cancer pain in children?
Settings: 18 countries.
Bibliography: Wiffen PJ, McQuay HJ. Oral morphine for cancer pain. Cochrane Database of Systematic
Reviews, 2007 (4):CD003868.

Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations Immediate- release morphine Modified- release morphine Relative (95% CI) Absolute Quality

Pain relief (follow-up: 4–30 days; validated scales)
15 Rand- No No Seri- No None Not Not Similar – MOD-
omized serious serious ous a serious calcu- calcu- results ERATE
trials limita- incon- impre- lated lated from
tions sist- cision both
ency arms b
Adverse events (follow-up: 3–30 days; generally self report)
15 Rand- No No Seri- No None Data – No – MOD-
omized serious serious ous a serious not evalu- ERATE
trials limita- incon- impre- avail- able
tions sist- cision able by data c
ency group c
CI, confidence interval.
a All studies conducted in adults: setting 18 countries (11 European, 3 Asia, 2 North America, 2 Oceania).
b Studies showed that similar analgesia could be obtained using either modified-release or immediate-release
morphine. Total patients: 3615 (54 RCTs).
c No data available by group. Approximately 6% of participants (adults) in the studies who received morphine (any
type) found the adverse effects intolerable.

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