comparison of analgesic effects of nebulized morphine with fentanyl transdermal patch and oral methadone for cancer patients in terminal stages; a double-blind randomized controlled study

Introduction: recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy.objective: this study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients.method: this double-blind, randomized controlled study conducted between april and september 2017. ninety eligible cancer patients presenting to sayed al-shohada hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. pain severity was scored by visual analog scale (vas). patients were followed up for 3 days and then data were analyzed by spss. the benchmark of success was set as marking 4 or below on vas and a reduction ratio of 50 percent.results: pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6-10) at baseline to 2.46 (range 1-4) at the end of the 3rd day in the nebulized group. the decrease ratio was equal to 70.8% after three days (p<0.05). pain severity reduced from 8.45 (range 7-10) to 1.8 (range 1-3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6-10) to 2.13 (range 1-3) in the fentanyl group.conclusion: our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer.