Does the addition of dexmedetomidine to morphine have any clinical benefit on the treatment of pain in patients with metastatic cancer? A pilot study

Morphine is the first line drug for moderate to severe pain; however, due to side effects it may contribute to discomfort. Dexmedetomidine has both sedative and analgesic actions with a morphine sparing effect and can be used in metastatic cancer patients with intractable pain. This pilot project primarily aims to evaluate the effect of dexmedetomidine on pain treatment in patients with metastatic cancer. In addition, the work aims to determine its impact on anxiety and quality of communication of patients with their family members. Patients between 18 and 75 years, with metastatic cancer, who failed multiple pain treatments at home and admitted to the hospital for pain management were included. Patients were allocated randomly to Group A (who received morphine plus normal saline solution) or Group B (who received morphine plus dexmedetomidine) for pain management. The Visual Analogue Score (VAS) was used to assess pain intensity, a 5-point sedation scale was used to assess sedation level, and the Hamilton scale was used to assess anxiety. Results have shown that morphine consumption was reduced at different time points up to 48 h, p < 0.005 in both groups. There was a trend in decreasing pain scores after 36 h in both groups. All patients in Group A required rescue pain treatment; however, in Group B, this percentage was lower (67%). Communication was better in patients allocated to Group B than patients in Group A. To conclude, dexmedetomidine was safe and has exerted an opioid-sparing effect in patients with metastatic cancer with keeping their anxiety levels within an acceptable range.