Opioid switching to improve pain relief and drug tolerability

Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study

“…We observed, as have others [9,10,12,13,18], that the opioid switch group represented a population of patients with difficult pain control. At the baseline, patients in the switch group experienced worse pain (background, breakthrough, and incident pain), more neuropathic pain (a higher S-LANNS score), a greater influence of pain on function (functional items from the BPI), adverse effects (items from ESAS), and psychological distress (one item from ECS-CP).…”

Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study

“…We observed, as have others [9,10,12,13,18], that the opioid switch group represented a population of patients with difficult pain control. At the baseline, patients in the switch group experienced worse pain (background, breakthrough, and incident pain), more neuropathic pain (a higher S-LANNS score), a greater influence of pain on function (functional items from the BPI), adverse effects (items from ESAS), and psychological distress (one item from ECS-CP).…”

The Burden of Opioid Adverse Events and the Influence on Cancer Patients' Symptomatology

“…In particular, constipation, drowsiness, and dry mouth were more frequent over the entire period of observation in patients previously treated with weak opioids than in opioid-na€ ıve ones. These observations were somewhat unexpected because we believed that a change in the opioid WHO step, as a switch, 22 could reduce the toxic effects. However, it is possible that the higher frequency of AEs in patients pretreated with weak opioids indicates more advanced disease in those patients.…”

Opioid Rotation in Cancer Pain Treatment

“…Altogether, the database survey and hand search identified 502 publications, 12 of which satisfied our inclusion criteria: three SRs (9,10,17), four RCTs (18-21), and five prospective observational studies without a control group (22-26). For the sake of completeness, the results of two SRs identified during the search for aggregated evidence in the years 2003 to 2010 were tabulated (8,27). None of the reviews had performed a meta-analysis of the individual studies' results.…”

“…The 2011 review by Dale (10), conceived as a followup to Quigley's Cochrane review (8), included 11 uncontrolled prospective studies (n = 280) of various opioids with low numbers of cases (n = 10 to 32). With regard to pain, seven studies reported a reduction of >3/10 points on the numeric rating scale (NRS).…”

“…Loss The Cochrane Risk of Bias Tool comprises seven domains, for each of which the risk of bias is estimated as high, low, or unclear. AE = adverse events, BPI/BPI-SF= Brief Pain Inventory (SF=short form), BTP= break-through pain, C = convenience, CTCAE = Common Terminology Criteria for Adverse Events version (3)(4)(5)(6)(7)(8) between day 0 and day 28. Median average pain (VRS) decreased from 6 (5-7) to 4 (2)(3)(4)(5) between day 0 and day 28; 56% of the patients reported a 30% reduction in pain on day 28, 41% a reduction of over 50-%.…”

Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study

“…We observed, as have others [9,10,12,13,18], that the opioid switch group represented a population of patients with difficult pain control. At the baseline, patients in the switch group experienced worse pain (background, breakthrough, and incident pain), more neuropathic pain (a higher S-LANNS score), a greater influence of pain on function (functional items from the BPI), adverse effects (items from ESAS), and psychological distress (one item from ECS-CP).…”

The Burden of Opioid Adverse Events and the Influence on Cancer Patients' Symptomatology

“…In particular, constipation, drowsiness, and dry mouth were more frequent over the entire period of observation in patients previously treated with weak opioids than in opioid-na€ ıve ones. These observations were somewhat unexpected because we believed that a change in the opioid WHO step, as a switch, 22 could reduce the toxic effects. However, it is possible that the higher frequency of AEs in patients pretreated with weak opioids indicates more advanced disease in those patients.…”

Opioid Rotation in Cancer Pain Treatment

“…Altogether, the database survey and hand search identified 502 publications, 12 of which satisfied our inclusion criteria: three SRs (9,10,17), four RCTs (18-21), and five prospective observational studies without a control group (22-26). For the sake of completeness, the results of two SRs identified during the search for aggregated evidence in the years 2003 to 2010 were tabulated (8,27). None of the reviews had performed a meta-analysis of the individual studies' results.…”

“…The 2011 review by Dale (10), conceived as a followup to Quigley's Cochrane review (8), included 11 uncontrolled prospective studies (n = 280) of various opioids with low numbers of cases (n = 10 to 32). With regard to pain, seven studies reported a reduction of >3/10 points on the numeric rating scale (NRS).…”

“…Loss The Cochrane Risk of Bias Tool comprises seven domains, for each of which the risk of bias is estimated as high, low, or unclear. AE = adverse events, BPI/BPI-SF= Brief Pain Inventory (SF=short form), BTP= break-through pain, C = convenience, CTCAE = Common Terminology Criteria for Adverse Events version (3)(4)(5)(6)(7)(8) between day 0 and day 28. Median average pain (VRS) decreased from 6 (5-7) to 4 (2)(3)(4)(5) between day 0 and day 28; 56% of the patients reported a 30% reduction in pain on day 28, 41% a reduction of over 50-%.…”

Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study

“…We observed, as have others [9,10,12,13,18], that the opioid switch group represented a population of patients with difficult pain control. At the baseline, patients in the switch group experienced worse pain (background, breakthrough, and incident pain), more neuropathic pain (a higher S-LANNS score), a greater influence of pain on function (functional items from the BPI), adverse effects (items from ESAS), and psychological distress (one item from ECS-CP).…”

The Burden of Opioid Adverse Events and the Influence on Cancer Patients' Symptomatology

“…In particular, constipation, drowsiness, and dry mouth were more frequent over the entire period of observation in patients previously treated with weak opioids than in opioid-na€ ıve ones. These observations were somewhat unexpected because we believed that a change in the opioid WHO step, as a switch, 22 could reduce the toxic effects. However, it is possible that the higher frequency of AEs in patients pretreated with weak opioids indicates more advanced disease in those patients.…”

Opioid Rotation in Cancer Pain Treatment

“…Altogether, the database survey and hand search identified 502 publications, 12 of which satisfied our inclusion criteria: three SRs (9,10,17), four RCTs (18-21), and five prospective observational studies without a control group (22-26). For the sake of completeness, the results of two SRs identified during the search for aggregated evidence in the years 2003 to 2010 were tabulated (8,27). None of the reviews had performed a meta-analysis of the individual studies' results.…”

“…The 2011 review by Dale (10), conceived as a followup to Quigley's Cochrane review (8), included 11 uncontrolled prospective studies (n = 280) of various opioids with low numbers of cases (n = 10 to 32). With regard to pain, seven studies reported a reduction of >3/10 points on the numeric rating scale (NRS).…”

“…Loss The Cochrane Risk of Bias Tool comprises seven domains, for each of which the risk of bias is estimated as high, low, or unclear. AE = adverse events, BPI/BPI-SF= Brief Pain Inventory (SF=short form), BTP= break-through pain, C = convenience, CTCAE = Common Terminology Criteria for Adverse Events version (3)(4)(5)(6)(7)(8) between day 0 and day 28. Median average pain (VRS) decreased from 6 (5-7) to 4 (2)(3)(4)(5) between day 0 and day 28; 56% of the patients reported a 30% reduction in pain on day 28, 41% a reduction of over 50-%.…”