Intravenous morphine titration to treat severe pain in the ED

Am J Emerg Med. 2008 Jul;26(6):676-82. doi: 10.1016/j.ajem.2007.10.025.


Purpose: We assessed the safety of intravenous morphine titration in the emergency setting.

Methods: A total of 621 consecutive adult patients admitted in the ED with acute severe pain (visual analogue scale pain score > 70) were included. Intravenous morphine titration was administered as a bolus of 2 (body weight < or = 60 kg) or 3 mg (body weight > 60 kg) with 5-minute interval between each bolus. Pain relief was defined as a visual analogue pain score of 30 or lower.

Results: The dose of morphine administered was 0.16 +/- 0.10 mg/kg and the median number of boluses was 3. Pain relief was obtained in 512 (82%) patients. Morphine-induced adverse events occurred in 67 patients (11%) without severe adverse event. Titration was interrupted before pain relief had been obtained in 107 (17%) patients. In the remaining 514 patients, pain relief was obtained in 507 (99%) patients. Two variables were significantly associated with no pain relief: major protocol deviation (odds ratio, 17.3; 95% confidence interval, 10.0-30.1) and morphine-induced adverse effect (odds ratio, 13.0; 95% confidence interval, 6.7-25.3).

Conclusion: Intravenous morphine titration is a safe and effective option for severe pain when used according to a strict protocol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage*
  • Dose-Response Relationship, Drug
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Morphine / administration & dosage*
  • Pain / drug therapy*
  • Pain Measurement
  • Prospective Studies
  • Statistics, Nonparametric


  • Analgesics, Opioid
  • Morphine