Opioid rotation in cancer pain

Mercadante, Sebastiano

doi:10.1007/s11916-998-0010-9

Cited by 7 publications

(6 citation statements)

References 107 publications

(93 reference statements)

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“…The mean age of the 12 men and 7 women was 65.7 years (range 42 ± 86 years) and all were Caucasian. Patients most frequently had some medical history in connection with allergies (6) and gastrointestinal system (6), and concomitant conditions were particularly noted for respiratory (10), gastrointestinal (8) and musculoskeletal (8) systems. Medication taken by just over half of patients before the study included antacids and corticosteroids.…”

Section: Patient Characteristics At Baselinementioning

confidence: 99%

“…In this situation, it is often beneficial to change to an alternative strong opioid, and the term`opioid rotation' has been used to describe the substitution of one opioid for another to obtain a more favourable balance between analgesia and toxicity. 5,6 Opioid switching' is a more accurate description. Successful opioid switching from morphine to eight different opioids has been documented 5 and has shown improvement in persistent troublesome side effects.…”

Section: Introductionmentioning

confidence: 99%

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Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care

McNamara¹

2002

Palliat Med

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The study objective was to determine whether switching patients from morphine to transdermal fentanyl resulted in a reduction of morphine-associated side effects, and an improvement in cognitive function and patients' well being while maintaining adequate pain and symptom control. Nineteen patients aged 42-86 with terminal cancer, maintained on morphine for pain and distressed as a result of morphine toxicity, were given the dose of fentanyl corresponding to their current morphine dose. Pain control was then maintained (mostly fentanyl 50-100 microg/h) over the 14-day study period. Throughout the study, patients' global assessment of well being (primary efficacy variable) was statistically significantly improved. Sleepiness and drowsiness were significantly less of a problem. There was a trend towards improvement in attention span/concentration, and in the power and quality of concentration. Cognitive function tests also revealed a significant improvement in working (short term) and speed of memory although not in secondary (long term) memory. Patients did not experience hallucinations or delusions and there was no change in levels of anxiety or depression (Hospital Anxiety Depression Scale). The incidence of dizziness was significantly reduced, and there was a nonsignificant decrease in number of patients who suffered myoclonus and in the severity of this condition over the 14 days. The investigator's overall impression of treatment with transdermal fentanyl was 'fair', which was not in agreement with the positive impression expressed by patients (score 74, range: 0 worst, 100 best). Further work is required to determine if the improvement in patients' well being and cognitive function is achieved in larger study populations.

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Section: Patient Characteristics At Baselinementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care

McNamara¹

2002

Palliat Med

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“…The biological basis for the variable sensitivity of individuals to opioids is multifactorial and some aspects are incompletely understood (19,20), but patients who respond poorly to oral morphine, for example, will frequently tolerate an alternative opioid. This may be particularly pertinent in the case of buprenorphine, which exhibits atypical receptor binding (21), is uniquely sensitive to the effects of adenosine triphosphate-sensitive potassium channel openers and blockers (22), and is significantly more potent than other opioids in the rat neonate formalin test (23).These findings suggest the existence of a separate pain transmission pathway, which can be interrupted by buprenorphine analgesia, but is not accessible to other opioids (24).…”

Section: Discussionmentioning

confidence: 99%

Challenging the equipotency calculation for transdermal buprenorphine: four case studies

Likar

Krainer

Sittl

2007

International Journal of Clinical Practice

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“…6 Opioid rotation was defined as the substitution of one opioid for another to obtain a more favorable analgesia to side-effect profile. 7 Pain intensity was determined by self-report, whenever possible, or proxy reporting by the child's nurse when this was not possible. The measurement tools used were the Wong Baker FACES scale 8 or visual analogue scale.…”

Section: Methodsmentioning

confidence: 99%

Opioid Rotation in Children with Cancer

Drake

Longworth

Collins

2004

Journal of Palliative Medicine

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The purpose of this retrospective study was to determine the therapeutic value of opioid rotation in a large pediatric oncology center. The details for opioid prescriptions, over the course of a year, were obtained from the medical records of children with cancer who had a rotation of opioid during their admission. Twenty-two children or 14% of children on opioid therapy underwent 30 opioid rotations. Mucositis was the cause of pain in 19 (70%) children, bone pain in 3 (11%) children, and postoperative, visceral, or neuropathic pain in the remainder. The opioid was rotated either for excessive side effects with adequate analgesia (70%), excessive side effects with inadequate analgesia (16.7%), or tolerance (6.7%). Five (23%) children required two rotations, 3 during the same admission. The favored rotations were morphine to fentanyl in 20 (67%) children and fentanyl to hydromorphone in 6 (20%). Adverse opioid effects were resolved in 90% of cases, all failures occurred when morphine was rotated to fentanyl. There was no significant loss of pain control or increase in mean morphine equivalent dose requirements. Opioid rotation had a positive impact on managing dose-limiting side effects of, or tolerance to, opioid therapy during cancer pain treatment in children. This was accomplished without loss of pain control or having to significantly increase the dose of opioid therapy.

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Opioid rotation in cancer pain

Cited by 7 publications

References 107 publications

Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care

Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care

Challenging the equipotency calculation for transdermal buprenorphine: four case studies

Opioid Rotation in Children with Cancer

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