The ACTION study: A randomized, open-label, multicenter trial comparing once-a-day extended-release morphine sulfate capsules (AVINZA®) to twice-a-day controlled-release oxycodone hydrochloride tablets (OxyContin®) for the treatment of chronic, moderate to severe low back pain


  • Richard L. Rauck, MD
  • Stephen A. Bookbinder, MD
  • Timothy R. Bunker, MD
  • Christopher D. Alftine, MD
  • Richard Ghalie, MD
  • Andres Negro-Vilar, MD, PhD
  • Egbert de Jong, MD
  • Steven Gershon, MD



AVINZA, OxyContin, chronic low back pain


This large, open-label, randomized, parallel-group, multicenter study compared two oral sustained-release opioids (SROs)—AVINZA® (A-MQD), morphine sulfate extended-release capsules given once a day, and OxyContin® (O-ER), oxycodone modified-release tablets given twice a day—in SRO-naive subjects ages 30 to 70 with chronic, moderate to severe low back pain. Of the 392 subjects enrolled and randomized, 266 (132 in the AMQD group and 134 in the O-ER group) completed the opioid dose titration phase and entered an eight-week evaluation phase. During the evaluation phase, A-MQD achieved significantly better pain control than O-ER, as demonstrated by a greater decrease from baseline in pain scores obtained four times daily during weeks one, four, and eight (p = 0.002). The number of breakthrough-pain rescue medication doses adjusted for the number of patient days was significantly lower in the A-MQD group (p < 0.0001). Better pain control with A-MQD was achieved with a significantly lower daily opioid dose than with O-ER (mean 69.9 mg and 91 mg morphine equivalents, respectively; p = 0.0125). Quality of sleep was significantly better with A-MQD for the entire evaluation phase (p = 0.0026). The incidence and severity of elicited opioid side effects were similar in the two groups. This trial demonstrated that once-daily A-MQD provides consistent around-the-clock pain relief in patients with low back pain. In patients who completed opioid dose titration, A-MQD was significantly better than O-ER for reducing pain and improving sleep, while requiring a lower daily opioid dose.

Author Biographies

Richard L. Rauck, MD

Carolinas Pain Institute, Winston-Salem, North Carolina.

Stephen A. Bookbinder, MD

Ocala Rheumatology Research Center, Ocala, Florida.

Timothy R. Bunker, MD

The Birmingham Pain Center, Birmingham, Alabama.

Christopher D. Alftine, MD

Medford Medical Clinic, Medford, Oregon.

Richard Ghalie, MD

Ligand Pharmaceuticals Inc., San Diego, California.

Andres Negro-Vilar, MD, PhD

Ligand Pharmaceuticals Inc., San Diego, California.

Egbert de Jong, MD

Organon Pharmaceuticals USA Inc., Roseland, New Jersey.

Steven Gershon, MD

Advanced Pain Management and Rehabilitation PC, Virginia Beach, Virginia.


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How to Cite

Rauck, MD, R. L., S. A. Bookbinder, MD, T. R. Bunker, MD, C. D. Alftine, MD, R. Ghalie, MD, A. Negro-Vilar, MD, PhD, E. de Jong, MD, and S. Gershon, MD. “The ACTION Study: A Randomized, Open-Label, Multicenter Trial Comparing Once-a-Day Extended-Release Morphine Sulfate Capsules (AVINZA®) to Twice-a-Day Controlled-Release Oxycodone Hydrochloride Tablets (OxyContin®) for the Treatment of Chronic, Moderate to Severe Low Back Pain”. Journal of Opioid Management, vol. 2, no. 3, May 2006, pp. 155-66, doi:10.5055/jom.2006.0025.