Opioid switch in palliative care, opioid choice by clinical need and opioid availability

Müller-Busch, H. Christof; Lindena, G.; Tietze, K.; Woskanjan, Susanne

doi:10.1016/j.ejpain.2004.12.003

Cited by 29 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The true opioid switching rate was about 12% and was higher in the inpatient setting. 17 Interestingly, change to the parenteral route accounted for a further 30% of opioid substitutions.…”

Section: Discussionmentioning

confidence: 99%

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Mercadante

Valle²,

Porzio³

et al. 2013

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context. Opioid switching has been found to improve opioid responsiveness in different conditions. However, data on opioid switching performed at home are almost nonexistent, despite the fact that most patients are followed at home.Objectives. The aim of this retrospective survey was to determine frequency, indications, usefulness, and safety of opioid switching when treating advanced cancer-related pain in patients followed at home.Methods. A retrospective review of data from patients with advanced cancer followed at home by three home care teams for a period of two years was performed. Patients who had their opioids switched were selected. Reasons for switching opioid doses and routes of administration and outcomes were collected.Results. Two hundred one (17%) of 1141 patients receiving ''strong'' opioids were switched. The mean Karnofsky Performance Status score was 35.6, and the median survival was 30 days. The most frequent reason to switch was for convenience, and the most frequent switch was to parenteral morphine. In most patients, a better analgesic response was observed. Patients who were switched to parenteral morphine had a shorter survival in comparison with other opioid sequences (P < 0.0005). After switching, opioid doses were increased by 23% and 41%, after a week and at time of death, respectively.Conclusion. Opioid switching was useful for most patients in the home environment, at least in less complex circumstances, when done by experienced home care teams. Prospective studies are needed to provide information about the decision to admit to hospital for this purpose and the predictive factors that may relatively contraindicate transportation to a facility in severely ill patients. J Pain Symptom Manage 2013;45:298e304. Ó

show abstract

“…The true opioid switching rate was about 12% and was higher in the inpatient setting. 17 Interestingly, change to the parenteral route accounted for a further 30% of opioid substitutions.…”

Section: Discussionmentioning

confidence: 99%

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Mercadante

Valle²,

Porzio³

et al. 2013

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…In most studies the patient population was unclearly described. Moreover, only five studies gave some indication that advanced cancer patients were included in the study [19–23]. Unfortunately, these studies reported only over a short period of follow-up (7–28 days) and clear information on previous opioid use was lacking (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids

Oldenmenger

Lieverse

Janssen

et al. 2011

Support Care Cancer

View full text Add to dashboard Cite

PurposeThe effectiveness of an opioid rotation to parenteral hydromorphone in advanced cancer patients has never been investigated. Therefore, the purpose of this study was to investigate the analgesic efficacy and side effects of parenteral hydromorphone on serious cancer-related pain.MethodsWe included 104 consecutive advanced cancer patients who were extensively pretreated with opioids. They were rotated to parenteral hydromorphone because they failed to achieve adequate pain relief on other opioids. Pain intensity and side effects were daily assessed. The moment of adequate pain control was defined as the first of at least 2 consecutive days when the mean pain intensity at rest was ≤4 (on a 0–10 numeric rating scale) and side effects were tolerable.ResultsThe reasons for rotation to parenteral hydromorphone were inadequate pain control with/without expected delivery problems due to high opioid dosages (n = 61) and intolerable side effects with persistent pain (n = 43). Adequate pain control was achieved in 86 patients (83%) within a mean of 5 days. Eight of 86 patients still had side effects, but these were scored as acceptable. The mean pain intensity at rest decreased from 5.4 [standard deviation (sd) = 2.1] to 2.4 (sd = 1.5; p < 0.001). The median failure-free treatment period was 57 days and covered a substantial part of the median survival of 78 days in the responding patients.ConclusionsIn advanced cancer patients with serious unstable cancer-related pain refractory to other opioids, continuous parenteral administration of hydromorphone often results in long-lasting adequate pain control and should be considered even after extensive pretreatment with opioids.

show abstract

“…Retrospective studies indicate that in 21 to 44% of the patients, opioid rotation is used 52–56 . In prospective studies, those percentages are 12 57 and 25% 58 . There are no randomized controlled trials investigating the efficacy of opioid rotation.…”

Section: Evidence On Opioid Rotationmentioning

confidence: 99%

“…Since then, more information has become available. Published studies are often based on retrospective chart reviews, but prospective studies have also been conducted 52,57 . Almost all trials demonstrated that opioid rotation results in a better pain relief and/or less side effects.…”

Section: Evidence On Opioid Rotationmentioning

confidence: 99%

Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?

et al. 2010

View full text Add to dashboard Cite

Abstract:The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World Health Organization ladder for cancer pain management, are reserved for the end stage of life. Recent information indicates the potential value of strong opioids in the treatment of chronic nonmalignant pain. There are, up until now, insufficient data to provide indications about which opioid to use to initiate treatment or the dose to be used for any specific pain syndrome. The strong inter-patient variability in opioid receptor response and in the pharmacokinetic and pharmacodynamic behavior of strong opioids justifies an individual selection of the appropriate opioid and stepwise dose titration. Clinical experience shows that switching from one opioid to another may optimize pain control while maintaining an acceptable side effect profile or even improving the side effects. This treatment strategy, described as opioid rotation or switch, requires a dose calculation for the newly started opioid. Currently, conversion tables and equianalgesic doses are available. However, those recommendations are often based on data derived from studies designed to evaluate acute pain relief, and sometimes on single dose studies, which reduces this information to the level of an indication. In daily practice, the clinician needs to titrate the optimal dose during the opioid rotation from a reduced calculated dose, based on the clinical response of the patient. Further research and studies are needed to optimize the equianalgesic dosing tables.

show abstract

Opioid switch in palliative care, opioid choice by clinical need and opioid availability

Cited by 29 publications

References 36 publications

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids

Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?

Contact Info

Product

Resources

About