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  1. Fulltext Methanolic Extract of Clinacanthus nutans Exerts Antinociceptive Activity via the Opioid/Nitric Oxide-Mediated, but cGMP-Independent, Pathways
    Abdul Rahim MH, Zakaria ZA, Mohd Sani MH, Omar MH, Yakob Y, Cheema MS, et al.
    Evid Based Complement Alternat Med, 2016;2016:1494981.
    PMID: 27190528 DOI: 10.1155/2016/1494981
    The objectives of the present study were to determine the mechanisms of antinociceptive effect of methanol extract of Clinacanthus nutans (Acanthaceae) leaves (MECN) using various animal nociceptive models. The antinociceptive activity of orally administered 10% DMSO, 100 mg/kg acetylsalicylic acid (ASA), 5 mg/kg morphine, or MECN (100, 250, and 500 mg/kg) was determined using the acetic acid-induced abdominal constriction (ACT), formalin-induced paw licking (FT), and hot plate tests (HPT). The role of opioid and nitric oxide/cyclic guanosine monophosphate (NO/cGMP) systems was also investigated. The results showed that MECN produced a significant (p < 0.05) antinociceptive response in all nociceptive models with the recorded ED50 value of 279.3 mg/kg for the ACT, while, for the early and late phases of the FT, the value was >500 mg/kg or 227.7 mg/kg, respectively. This antinociceptive activity was fully antagonized by naloxone (a nonselective opioid antagonist) but was partially reversed by l-arginine (l-arg; a nitric oxide [NO] precursor), Nω-nitro-l-arginine methyl ester hydrochloride (l-NAME; an NO synthase inhibitor), or their combinations thereof. In contrast, 1H-[1,2,4]oxadiazole[4,3-a]quinoxalin-1-one (ODQ; a soluble guanylyl cyclase inhibitor) enhanced the extract's antinociception. UHPLC analysis revealed the presence of several flavonoid-based compounds with antinociceptive action. In conclusion, MECN exerted the peripherally and centrally mediated antinociceptive activity via the modulation of the opioid/NO-mediated, but cGMP-independent, systems.
    Matched MeSH terms: Morphine
  2. Fulltext A comparative study of intravenous patient-controlled analgesia morphine and tramadol in patients undergoing major operation
    Hadi MA, Kamaruljan HS, Saedah A, Abdullah NM
    Med J Malaysia, 2006 Dec;61(5):570-6.
    PMID: 17623958
    The success of major surgery depends partly on providing effective post-operative pain relief, which can be commonly achieved by morphine administration via patient- controlled analgesic (PCA) system. Alternatively, tramadol which is a weak opioid analgesic, can be used for post operative pain relief. The purpose of this study was to evaluate the effectiveness of intravenous PCA tramadol in comparison with PCA morphine in term of analgesic properties, sedation and side effects. A randomized, double-blinded study was conducted on 160 ASA I and II patients who underwent major operations. Eighty of them received a loading dose of intravenous morphine 0.1 mg/kg followed by PCA morphine bolus of 1 mg (1 mg/ml) as required, while the other 80 patients received a loading dose of 2.5 mg/kg of intravenous tramadol followed by PCA infusion of 10 mg (10 mg/ml) as required. Patients were monitored for pain, sedation and side effects as well as respiratory rate, nausea, vomiting, pruritus, blood pressure and pulse rate. Patients were evaluated 30 minutes, 4 hours, 24 hours and 48 hours post operation. There were no differences in the demographic data between the two groups (p > 0.05). The overall mean pain score in tramadol group was 0.70 +/- 0.60 as compared to 0.75 +/- 0.67 for morphine group. The mean pain score for tramadol and morphine groups at 30 minutes, 4 hours, 24 hours and 48 hours post operation were 1.32 +/- 0.79, 104 +/- 0.79, 0.35 +/- 0.48, 0.09 +/- 0.33 and 1.35 +/- 0.99, 1.14 +/- 0.81, 0.40 +/- 0.54, 0.10 +/- 0.34 respectively. The overall mean sedation score in tramadol and morphine group was 0.39 +/- 0.44 as compared to 0.35 +/- 0.43 for morphine group. The mean sedation score for tramadol and morphine group at 30 minutes, 4 hours, 24 hours and 48 hours post operation were 0.90 +/- 0.74, 0.56 +/- 0.59, 0.075 +/- 0.27, 0.025 +/- 0.16 and 0.84 +/- 0.70, 0.46 +/- 0.64, 0.08 +/- 0.27, 0.01 +/- 0.11 respectively. There was no significant difference in the overall mean pain and sedation score between the two groups as well as for each duration assessed (p > 0.05). There were also no significant differences between the two groups with regard to the blood pressure and heart rate. The incidence of nausea, vomiting and pruritus were the same in the two groups. This study indicates that PCA tramadol is as equally effective as PCA morphine control following major surgery. The incidences of sedation, nausea or pruritus were the same in the two groups.
    Matched MeSH terms: Morphine/administration & dosage; Morphine/therapeutic use*
  3. Gabapentin completely attenuated the acute morphine-induced c-Fos expression in the rat nucleus accumbens
    Kazi JA, Abu-Hassan MI
    J Mol Neurosci, 2011 Oct;45(2):101-9.
    PMID: 20734160 DOI: 10.1007/s12031-010-9435-9
    A growing body of evidence suggests the existence of a functional interaction between gabapentin (GBP)-morphine system. However, the neuro-anatomical sites and molecular mechanism of action of gabapentin-morphine interaction to prevent and reverse morphine side effects as well as enhancement of the analgesic effect of morphine is not clear. Therefore, we examined the combined effects of GBP-morphine on acute morphine-induced c-Fos expression in rat nucleus accumbens. The combined effect of GBP-morphine was examined by means of c-Fos immunohistochemistry. A single intraperitoneal injection (i.p.) of morphine (10 mg/kg), saline (control), and co-injection of GBP (150 mg/kg) with morphine (5 mg/kg) was administered under anesthesia. The deeply anesthetized rats were perfused transcardially with 4% paraformaldehyde 2 h after drugs administration. Serial 40 μm thick sections of brain were cut and processed by immunohistochemistry to locate and quantify the sites and number of neurons with c-Fos immunoreactivity. Detection of c-Fos protein was performed using the peroxidase-antiperoxidase detection protocol. The present study demonstrated that, administration of GBP (150 mg/kg, i.p.) in combination with morphine (5 mg/kg, i.p.) significantly (p < 0.01) attenuated the acute morphine (5 mg/kg, i.p.)-induced c-Fos expression in the rat nucleus accumbens shell. Present results showed that GBP-morphine combination action prevented the acute morphine-induced c-Fos expression in rat nucleus accumbens. Moreover, this study provides first evidence of neuro-anatomical site and that GBP neutralized the morphine-induced activation of rat nucleus accumbens shell.
    Matched MeSH terms: Morphine/metabolism; Morphine/pharmacology*
  4. The effect of mitragynine on cAMP formation and mRNA expression of mu-opioid receptors mediated by chronic morphine treatment in SK-N-SH neuroblastoma cell
    Jamil MF, Subki MF, Lan TM, Majid MI, Adenan MI
    J Ethnopharmacol, 2013 Jun 21;148(1):135-43.
    PMID: 23608241 DOI: 10.1016/j.jep.2013.03.078
    ETHNOPHARMACOLOGICAL RELEVANCE: [corrected] Mitragynine is an indole alkaloid compound of Mitragyna speciosa (M. speciosa) Korth. (Rubiaceae). This plant is native to the southern regions of Thailand and northern regions of Malaysia and is frequently used to manage the withdrawal symptoms in both countries.

    AIM OF STUDY: To investigate the effect of mitragynine after chronic morphine treatment on cyclic AMP (cAMP) level and mRNA expression of mu-opioid receptor (MOR) in human neuroblastoma SK-N-SH cell.

    METHOD AND MATERIALS: Mitragynine was isolated from the Mitragyna speciosa plant using the acid-base extraction method. The cAMP level upon forskolin stimulation in the cells was determined using the Calbiochem(®) Direct Immunoassay Kit. The mRNA expression of the MOR was carried out using quantitative RT-PCR.

    RESULT: Cotreatment and pretreatment of morphine and mitragynine significantly reduced the production of cAMP level at a lower concentration of mitragynine while the higher concentration of this compound could lead to the development of tolerance and dependence as shown by the increase of the cAMP level production in foskolin stimulation. In MOR mRNA expression study, cotreatment of morphine with mitragynine significantly reduced the down-regulation of MOR mRNA expression as compared to morphine treatment only.

    CONCLUSION: These finding suggest that mitragynine could possibly avoid the tolerance and dependence on chronic morphine treatment by reducing the up-regulation of cAMP level as well as reducing the down-regulation of MOR at a lower concentration of mitragynine.

    Matched MeSH terms: Morphine/administration & dosage*
  5. Fulltext Profound swim stress-induced analgesia with ketamine
    Ahmad AH, Ismail Z, Than M, Ahmad A
    Malays J Med Sci, 2008 Jan;15(1):13-22.
    PMID: 22589610 MyJurnal
    The potential of ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, in preventing central sensitization has led to numerous studies. Ketamine is increasingly used in the clinical setting to provide analgesia and prevent the development of central sensitization at subanaesthetic doses. However, few studies have looked into the potential of ketamine in combination with stress-induced analgesia. This study looks at the effects of swim stress, which is mediated by opioid receptor, on ketamine analgesia using formalin test. Morphine is used as the standard analgesic for comparison. Adult male Sprague-Dawley rats were assigned to 6 groups: 3 groups (stressed groups) were given saline 1ml/kg intraperitoneally (ip), morphine 10mg/kg ip or ketamine 5mg/kg ip and subjected to swim stress; 3 more groups (non-stressed groups) were given the same drugs without swim stress. Formalin test, which involved formalin injection as the pain stimulus and the pain score recorded over time, was performed on all rats ten minutes after cessation of swimming or 30 minutes after injection of drugs. Combination of swim stress and ketamine resulted in complete analgesia in the formalin test which was significantly different from ketamine alone (p<0.05) and saline with stress (p<0.01). There is no significant difference between ketamine stressed and morphine stressed. These results indicate that ketamine and swim stress act synergistically to produce profound analgesia in the formalin test. This suggests that in the clinical setting, under stressful situations such as operative stress, ketamine is capable of producing profound analgesia at a subanaesthetic dose.
    Matched MeSH terms: Morphine
  6. Fulltext Intravenous parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department
    Baharuddin KA, Rahman NH, Wahab SF, Halim NA, Ahmad R
    Int J Emerg Med, 2014;7(1):2.
    PMID: 24386899 DOI: 10.1186/1865-1380-7-2
    BACKGROUND: Parecoxib sodium is the first parenteral COX-2 inhibitor used for pain management licensed for postoperative pain. However, no study has assessed the usage of parecoxib for acute traumatic pain in the emergency department (ED). The objective of this study was to investigate a potential alternative analgesic agent in the ED by determining the mean reduction of pain score between acute traumatic pain patients who were administered with intravenous (IV) parecoxib sodium versus IV morphine sulfate. The onset of perceptible analgesic effect and side effects were also evaluated.
    METHODS: A randomized, double-blinded study comparing IV parecoxib 40 mg versus IV morphine at 0.10 mg/kg was conducted in adult patients presented with acute traumatic pain with numeric rating scale (NRS) of 6 or more within 6 hours of injury. Patients were randomized using a computer-generated randomization plan. Drug preparation and dispensing were performed by a pharmacist. Periodic assessment of blood pressure, pulse rate, oxygen saturation, and NRS were taken at 0, 5, 15, and 30 minute intervals after the administration of the study drug. The primary outcome was the reduction of NRS. Side effect and drug evaluation was conducted within 30 minutes of drug administration.
    RESULTS: There was no statistically significant difference in the reduction of mean NRS between patients in the IV parecoxib group or IV morphine group (P = 0.095). The mean NRS for patients treated with IV morphine were 7.1 at 0 minutes, 4.5 at 5 minutes, 3.1 at 15 minutes, and 2.0 at 30 minutes. Whereas mean NRS for patients who received IV parecoxib were 7.8 at 0 minutes, 5.7 at 5 minutes, 4.7 at 15 minutes, and 3.9 at 30 minutes. The onset of perceptible analgesic effects could be seen as early as 5 minutes. Dizziness was experienced in 42.9% of patients who received IV morphine compared to none in the parecoxib group.
    CONCLUSIONS: There was non-significant trend toward superiority of IV morphine over IV parecoxib. Looking at its effectiveness and the lack of opioid-related side-effects, the usage of IV parecoxib sodium may be extended further to a variety of cases in the ED.
    Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM)
    Matched MeSH terms: Morphine*
  7. Fulltext The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation
    Chong, K.C., Sulaiman, A.R., Yusof, M.I., Vishvanathan, T., Anwar Hau, M.
    Malays Orthop J, 2010;4(3):3-6.
    MyJurnal
    Phantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients(Group A) and intramuscular diclofenac sodium in 28 patients (Group B) in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 %) patients from group A and 21 patients (75 %) from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p
    Matched MeSH terms: Morphine
  8. Fulltext A pilot study of enhance recovery after surgery (ERAS) for liver resection
    Jarmin, R., Othman, H., Zuhdi, Z., Mohamad, I.S., Ahmad, A.W., Ariffin, A.C.
    International Medical Journal Malaysia, 2017;16(2):41-45.
    MyJurnal
    Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
    surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
    time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
    liver resection was initiated.

    Objective: The aim of this study was to achieve discharge by postoperative
    day 3 for minor resection and day 5 for major resection.

    Design and Setting: This is a prospective study
    conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.

    Material
    and Methods: All patients undergoing open liver resection were included in the study. They were then
    managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
    demographics data, intra operative parameters, postoperative complications and adherence to
    postoperative recovery protocol were recorded.

    Results: Seventeen patients (7 major and 10 minor
    resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
    was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
    in the major group were discharged on time. 9 patients had postoperative complications with no mortality
    recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
    15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
    35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14
    patients).

    Conclusion: From these overall achievement, most of our targets have been met and this shows
    that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.

    Limitations: Some patients
    had achieved their target but not discharged for unknown reason.
    Matched MeSH terms: Morphine
  9. Fulltext The combination of mitragynine and morphine prevents the development of morphine tolerance in mice
    Fakurazi S, Rahman SA, Hidayat MT, Ithnin H, Moklas MA, Arulselvan P
    Molecules, 2013 Jan 04;18(1):666-81.
    PMID: 23292329 DOI: 10.3390/molecules18010666
    Mitragynine (MG) is the major active alkaloid found in Mitragyna speciosa Korth. In the present study, we investigated the enhancement of analgesic action of MG when combined with morphine and the effect of the combination on the development of tolerance towards morphine. Mice were administered intraperitoneally with a dose of MG (15 and 25 mg/kg b.wt) combined with morphine (5 mg/kg b.wt) respectively for 9 days. The antinociceptive effect was evaluated by a hot plate test. The protein expression of cyclic adenosine monophosphate (cAMP) and cAMP response element binding (CREB) was analyzed by immunoblot. Toxicological parameters especially liver and kidney function tests were assessed after the combination treatment with MG and morphine. The concurrent administration of MG and morphine showed significant (p < 0.05) increase in latency time when compared to morphine alone group and the outstanding analgesic effects in the combination regimens were maintained until day 9. For the protein expression, there was a significant increment of cAMP and CREB levels (p < 0.05) in group treated with 5 mg/kg morphine but there was no significant change of these protein expressions when MG was combined with morphine. There was a significant changes in toxicological parameters of various treated groups. The combination treatment of MG and morphine effectively reduce the tolerance due to the chronic administration of morphine.
    Matched MeSH terms: Morphine/administration & dosage*
  10. Fulltext Antinociceptive and anti-inflammatory effects of Stachytarpheta jamaicensis (L.) Vahl (Verbenaceae) in experimental animal models
    Sulaiman MR, Zakaria ZA, Chiong HS, Lai SK, Israf DA, Azam Shah TM
    Med Princ Pract, 2009;18(4):272-9.
    PMID: 19494533 DOI: 10.1159/000215723
    The present study was carried out to explore the antinociceptive as well as the anti-inflammatory effects of an ethanol extract of Stachytarpheta jamaicensis (L.) Vahl (EESJ) using 3 models of nociception and 2 models of inflammation in experimental animals.
    Matched MeSH terms: Morphine/pharmacology
  11. Fulltext Evaluation of Analgesic Activity of the Methanol Extract from the Galls of Quercus infectoria (Olivier) in Rats
    Fan SH, Ali NA, Basri DF
    Evid Based Complement Alternat Med, 2014;2014:976764.
    PMID: 25254062 DOI: 10.1155/2014/976764
    The present study aims to investigate the analgesic activity of the methanol extract of the galls of Quercus infectoria in rats using hot plate and tail-flick methods. The extract was administered intraperitoneally at a dose of 20 mg/kg while morphine sulfate and sodium salicylate (10 mg/kg) served as standards. The methanol extract exhibited significant analgesic activity in the tail-flick model (P < 0.05) by increasing the reaction time of the rats to 8.0 sec at 30 min after treatment in comparison to control (4.4 sec). Morphine sulfate produced a reaction time of 11.9 sec in the same test. At the peak of activity (30 min), the extract produced maximum possible analgesia (MPA) of 34.2%, whilst morphine sulfate achieved a peak MPA of 70.9%. No analgesic effects have been observed using sodium salicylate in the tail-flick model. In the same model, the extract and sodium salicylate demonstrated comparable reaction times. Tail-flick is a better method to evaluate analgesic activity as no significant results were observed for all treatments using hot plate with the exception of morphine sulfate, which showed significant results only at 45 and 60 min after treatment. In conclusion, the methanol extract of the galls of Quercus infectoria displayed analgesic activity.
    Matched MeSH terms: Morphine
  12. Fulltext Comparison of Adductor Canal Block Versus Local Infiltration Analgesia on Postoperative Pain and Functional Outcome after Total Knee Arthroplasty: A Randomized Controlled Trial
    Kampitak W, Tanavalee A, Ngarmukos S, Amarase C, Songthamwat B, Boonshua A
    Malays Orthop J, 2018 Mar;12(1):7-14.
    PMID: 29725506 DOI: 10.5704/MOJ.1803.002
    Introduction: Total knee arthroplasty (TKA) is associated with intense postoperative pain for which effective analgesia is essential to facilitate early postoperative recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) have become increasingly involved in postoperative pain management after TKA. We aimed to compare their efficacy and outcomes in patients undergoing TKA. Materials and Methods: Sixty patients undergoing unilateral TKA were randomized to receive either postoperative single-injection ACB (Group A) or LIA (Group L) during the operation. All patients received spinal anaesthesia. Primary outcome was total morphine consumption over postoperative 24 hours. Visual analog pain scale, time to first and total dosage of rescue analgesia, performance-based evaluations [timed-up and go (TUG) test, quadriceps strength], side-effects, length of hospital stay and patient satisfaction were measured. Results: Fifty-seven patients were available for analysis. Median total morphine consumption over 24 and 48 postoperative hours of Group A were significantly less than Group L (6/10 mg vs 13/25 mg, p, 0.008 and 0.001, respectively). Similarly, Group A had significantly lower VAS at postoperative 6, 12 and 18 hours, VAS at ambulation on postoperative (POD) 1-3, better TUG tests on POD 2 and during POD 3 than those of Group L. However, quadriceps strength and patient satisfaction were not different between both groups. Conclusion: Patients undergoing TKA with single-injection ACB required less postoperative opioids than those with LIA. Furthermore, multimodal analgesia using ACB provided better postoperative analgesia, as well as performance-based activities, than those with LIA.
    Matched MeSH terms: Morphine
  13. Median Nerve Stimulation as a Nonpharmacological Approach to Bypass Analgesic Tolerance to Morphine: A Proof-of-Concept Study in Mice
    Lee MT, Chen YH, Mackie K, Chiou LC
    J Pain, 2021 03;22(3):300-312.
    PMID: 33069869 DOI: 10.1016/j.jpain.2020.09.003
    Analgesic tolerance to opioids contributes to the opioid crisis by increasing the quantity of opioids prescribed and consumed. Thus, there is a need to develop non-opioid-based pain-relieving regimens as well as strategies to circumvent opioid tolerance. Previously, we revealed a non-opioid analgesic mechanism induced by median nerve electrostimulation at the overlaying PC6 (Neiguan) acupoint (MNS-PC6). Here, we further examined the efficacy of MNS-PC6 in morphine-tolerant mice with neuropathic pain induced by chronic constriction injury (CCI) of the sciatic nerve. Daily treatments of MNS-PC6 (2 Hz, 2 mA), but not electrostimulation at a nonmedian nerve-innervated location, for a week post-CCI induction significantly suppressed established mechanical allodynia in CCI-mice in an orexin-1 (OX1) and cannabinoid-1 (CB1) receptor-dependent fashion. This antiallodynic effect induced by repeated MNS-PC6 was comparable to that induced by repeated gabapentin (50 mg/kg, i.p.) or single morphine (10 mg/kg, i.p.) treatments, but without tolerance, unlike repeated morphine-induced analgesia. Furthermore, single and repeated MNS-PC6 treatments remained fully effective in morphine-tolerant CCI-mice, also in an OX1 and CB1 receptor-dependent fashion. In CCI-mice receiving escalating doses of morphine for 21 days (10, 20 and 50 mg/kg), single and repeated MNS-PC6 treatments remained fully effective. Therefore, repeated MNS-PC6 treatments induce analgesia without tolerance, and retain efficacy in opioid-tolerant mice via a mechanism that involves OX1 and CB1 receptors. This study suggests that MNS-PC6 is an alternative pain management strategy that maybe useful for combatting the opioid epidemic, and opioid-tolerant patients receiving palliative care. PERSPECTIVE: Median nerve stimulation relieves neuropathic pain in mice without tolerance and retains efficacy even in mice with analgesic tolerance to escalating doses of morphine, via an opioid-independent, orexin-endocannabinoid-mediated mechanism. This study provides a proof of concept for utilizing peripheral nerve stimulating devices for pain management in opioid-tolerant patients.
    Matched MeSH terms: Morphine/administration & dosage; Morphine/pharmacology*
  14. Dose and duration of opioid use in patients with cancer and noncancer pain at an outpatient hospital setting in Malaysia
    Zin CS, Rahman NA, Ismail CR, Choy LW
    Pain Pract, 2017 07;17(6):774-781.
    PMID: 27676695 DOI: 10.1111/papr.12525
    BACKGROUND: There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain.
    METHODS: This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups.
    RESULTS: A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of < 50 mg morphine equivalents. The chronic use of opioids (> 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group.
    CONCLUSIONS: The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest.
    Study site: outpatient clinic, hospital, Malaysia
    Matched MeSH terms: Morphine/administration & dosage
  15. Fulltext A comparative study of post operative analgesia, side effects profile and patient satisfaction using intrathecal fentanyl with and without morphine 0.1 mg in caesarean section
    Sawi W, Choy YC
    Middle East J Anaesthesiol, 2013 Feb;22(1):21-6.
    PMID: 23833846
    BACKGROUND: This was a double-blinded, prospective randomized controlled trial to compare the postoperative analgesia, side effects profile and overall satisfaction in patients who received intrathecal fentanyl with or without morphine for elective Caesarean.
    METHODS: Sixty ASA I and II parturients were randomized into two groups. Group I received intrathecal fentanyl with 0.1 mg morphine and Group II received intrathecal fentanyl only. Postoperatively, all patients were provided with oral analgesics. The degree of post-operative pain score was assessed by verbal pain score. The incidence of side effects was assessed every 4 hours for 24 hours, which included incidence of nausea, vomiting, pruritus, sedation and evidence of respiratory depression. Patient's overall satisfaction was also recorded.
    RESULTS: The verbal pain score was significantly lower in morphine group up to 20 hours postoperative period. The incidence of pruritus, nausea and vomiting were statistically significant up to 12 hours postoperative. There was no incidence of severe side effects in all the patients. There was significant difference between the morphine and no morphine group in terms of overall patient satisfaction.
    CONCLUSION: There was significant difference in terms of lower pain score, higher incidence of side effects with better patients' overall satisfaction in morphine group.
    Matched MeSH terms: Morphine/administration & dosage*; Morphine/adverse effects
  16. Fulltext Comparison of morphine with fentanyl added to intrathecal 0.5% hyperbaric bupivacaine for analgesia after caesarean section
    Siti Salmah G, Choy YC
    Med J Malaysia, 2009 Mar;64(1):71-4.
    PMID: 19852327 MyJurnal
    This was a prospective randomised, controlled, single-blind study done to determine the effect of intrathecal morphine 0.1 mg as compared with intrathecal fentanyl 25 microg in terms of analgesia and duration for postoperative pain relief after Caesarean section. Sixty ASA I or II parturients were randomised into two groups. Group 1 (n=33) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 0.1 mg morphine while Group 2 (n=27) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 25 microg fentanyl for spinal anaesthesia. Postoperatively, all patients were provided with patient controlled analgesia (PCA) morphine. Pain was assessed using visual analogue score (VAS) at 6, 12, 18 and 24 hours. Time to first demand of PCA morphine, cumulative PCA morphine requirement and opioid side effects were documented. The VAS for pain and the cumulative PCA morphine requirement were both significantly lower in Group 1 (p < 0.05) during the 24 hours study period. The time to first demand was also significantly longer in Group 1 (p < 0.05). Overall, there were no significant difference between the two groups in side effects, except for a high incidence of nausea and vomiting requiring treatment in Group B in the first six hours. In conclusion the addition of 0.1 mg morphine for spinal anaesthesia provided superior and longer postoperative analgesia after Caesarean section.
    Matched MeSH terms: Morphine/administration & dosage*; Morphine/adverse effects
  17. Fulltext Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia
    Devi BC, Tang TS, Corbex M
    Ann Oncol, 2008 Dec;19(12):2061-6.
    PMID: 18641007 DOI: 10.1093/annonc/mdn422
    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.
    Matched MeSH terms: Morphine/therapeutic use*
  18. What doctors know about cancer pain management: an exploratory study in Sarawak, Malaysia
    Devi BC, Tang TS, Corbex M
    J Pain Palliat Care Pharmacother, 2006;20(2):15-22.
    PMID: 16702132
    Effective cancer pain management is influenced by the attitudes and knowledge of treating physicians. A survey was conducted among the total population of government hospital doctors of Sarawak to study the barriers to cancer pain management. Two hundred and fifty-three respondents (83%) completed the survey. The study results highlight that knowledge about cancer pain management was low and barriers to morphine prescription were high. A majority of doctors were deterred from using morphine because of fear of addiction (36.5%) and respiratory depression (53.1%). Only 16.2% of the doctors chose the oral mode of administration to treat pain, furthermore 25% prescribed morphine on "PRN" basis. Doctors with undergraduate study in oncology consistently answered better suggesting that the situation can be improved by education. This study showed that barriers to morphine prescription and knowledge deficit amongst government doctors in Sarawak are strong but similar to those reported in western countries few years ago.
    Matched MeSH terms: Morphine/administration & dosage; Morphine/therapeutic use*
  19. HIV infection among injecting drug users in north-east Malaysia, 1992
    Singh S, Crofts N
    AIDS Care, 1993;5(3):273-81.
    PMID: 8218462 DOI: 10.1080/09540129308258610
    Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)
    Matched MeSH terms: Morphine Dependence/complications; Morphine Dependence/epidemiology; Morphine Dependence/rehabilitation
  20. A randomized controlled trial of patient-controlled analgesia compared with boluses of analgesia for the control of acute traumatic pain in the emergency department
    Rahman NH, DeSilva T
    J Emerg Med, 2012 Dec;43(6):951-7.
    PMID: 23068783 DOI: 10.1016/j.jemermed.2012.02.069
    The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery.
    Matched MeSH terms: Morphine/administration & dosage*
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