Study: Dextromethorphan Does Not Enhance Morphine Effects

[Each Hit]

not sure if this belongs here or the dxm area, but it's a news article, so it's going here


http://sciam.com/article.cfm?alias=d...modsrc=reuters

May 09, 2007

Dextromethorphan does not enhance morphine effects
By Martha Kerr

NEW YORK (Reuters Health) - Contrary to preliminary findings, the results of a phase III study failed to show that dextromethorphan significantly enhanced the analgesic effects of morphine in terminally ill patients. The findings are published in the Journal of Pain and Symptom Management.

Dr. Deborah J. Dudgeon of Queen's University in Kingston, Ontario, led a multicenter study of 65 patients with advanced cancer or chronic severe pain requiring 12-hour, slow-release morphine.

Patients were randomly assigned to slow-release morphine plus either placebo or dextromethorphan, 60 milligrams four times a day for seven days. Dextromethorphan was then increased to 120 milligrams four times a day for another seven days, if the patient could tolerate it.

Patients kept records of other medications used, pain scores and symptoms of nausea, drowsiness and insomnia.

Patients in the combination treatment arm had average pain scores of 12.6 compared with 15.8 for patients receiving morphine plus placebo. However, this reduction was not statistically significant, Dudgeon and colleagues report.

Dextromethorphan plus morphine also resulted in a reduction in the number of episodes of pain breakthrough requiring additional medication, in nine instances compared with eleven for morphine plus placebo. However, these differences were also not statistically significant.

The total morphine consumed was 550.9 milligrams in the treatment group compared with 597.1 in the placebo group, which also was not a significant difference.

"We had hoped that the combination would have been helpful in improving pain control," Dudgeon acknowledged in an interview with Reuters Health. "Previous animal and limited human studies had suggested that dextromethorphan should have been helpful."

The hypothesis was that dextromethorphan's properties would act synergistically with morphine to increase the opioid's analgesic properties while modulating opioid tolerance.

Side effects, primarily dizziness, were more common with combination treatment, although again, the differences were statistically insignificant.

"The usefulness of the addition of dextromethorphan to opioids was limited in part by its toxicity," Dudgeon commented. Based on the study findings, she told Reuters Health, "personally, I would not use it in cases of intractable pain."

"Each situation is different and therefore there is no one 'best' approach" to the treatment of intractable pain in this patient population, Dudgeon concluded. "Depending on the circumstances, I might try ketamine, methadone or intraspinal opioids" for the terminally ill patient with severe pain.

SOURCE: Journal of Pain and Symptom Management, April 2007.

[fnord]

Patients in the combination treatment arm had average pain scores of 12.6 compared with 15.8 for patients receiving morphine plus placebo. However, this reduction was not statistically significant, Dudgeon and colleagues report.

Dextromethorphan plus morphine also resulted in a reduction in the number of episodes of pain breakthrough requiring additional medication, in nine instances compared with eleven for morphine plus placebo. However, these differences were also not statistically significant.

The total morphine consumed was 550.9 milligrams in the treatment group compared with 597.1 in the placebo group, which also was not a significant difference.


hmmm im no sciantist but i see a diffrence...

[hoodabudda]

while on 770mg of dxm swim stubbed his toe on the door frame and he knew it was supposed to hurt but he felt only a swelling pressure and warmness in his toe.the next morning swim was almost limping and couldnt walk anywhere because after he walked his toe would start to kill.swim has also had a sore upper body from working out alot and he did dxm(probably around 400mg SDK) and remembers no more soreness in his muscles.considering it works on the same receptors as pcp,which is a vetranary anesthetic,it does have some analgesic propertys..

[Each Hit]

i noticed those things also. the term "statistically insignificant" simply means the effect and/or sample size was not large enough to make a definitive conclusion (though it would be nice if they cited what error values constitute statistical significance in their experiment). it does appear a slight change is evident, but these people have to have conclusive evidence to make definitive and legitimate scientific claims. with a sample size of 65, only very significant effects would be considered valid.

then again, maybe they were told by higher ups to keep dxm's opiate qualities low key...

[fnord]

yes it does have pain kiling propertys but this report is about low doses and how they effect the pin reliveing aspects of morphine,the report says dxm dosent help ouyt with morphine,but i think the doctors are biased and are ignoreing the facts,the stats clearly show that with small amounts of dxm doses of morphine can be lowerd slightly,and that patiants complain of less pain.swim would like to know who sponserd this study.might give more insight.

[darawk]

I don't know about these people, but DXM is a very good potentiator of opiates for SWIM.