Abstract
BackgroundFor cancer patients with inadequate pain relief, a switch to an alternative opioid is the preferred option for symptomatic improvement. However, multiple opioids are often simultaneously administered for anecdotal reasons. This prospective study evaluated pain response to either opioid rotation or combination in patients with uncontrolled cancer pain.MethodsPatients suffering with uncontrolled cancer pain despite dose titration were randomly assigned to opioid rotation group or opioid combination group. Patients answered a questionnaire that included items on pain severity (0 to 10) and interferences at baseline and after one week.ResultsOf the 50 patients registered, 39 patients answered the questionnaire after one week of treatment. After one week, the mean pain scores were significantly improved in both groups. Ten patients (42 %) in the rotation group and 16 patients (62 %) in the combination group reported that they achieved relief from pain (p = 0.08). The incidence of adverse events was similar in both groups, but fewer patients experienced constipation with opioid rotation than with combination (17 % vs. 42 %, respectively; p = 0.05). The frequency of rescue analgesics (50 % vs. 69 %; p = 0.17) and dose modification (29 % vs. 38 %; p = 0.49) were similar in the rotation and combination groups.ConclusionsFor patients with chronic uncontrolled cancer pain, both opioid rotation and combination strategies appear to provide significant relief of pain and improved patient satisfaction.Trial registrationThis study was registered in advance to ClinicalTrials.gov (no. NCT00478101).
Highlights
For cancer patients with inadequate pain relief, a switch to an alternative opioid is the preferred option for symptomatic improvement
Patients were eligible to participate in the study if their clinician considered they had chronic uncontrolled pain associated with a histologically confirmed solid cancer that required stronger opioid therapy than they had been taking and they were over 18 years of age
A total of 50 patients were randomized to the rotation group (n = 24) or the combination group (n = 26)
Summary
For cancer patients with inadequate pain relief, a switch to an alternative opioid is the preferred option for symptomatic improvement. Multiple opioids are often simultaneously administered for anecdotal reasons. This prospective study evaluated pain response to either opioid rotation or combination in patients with uncontrolled cancer pain. Experts agree that patients suffering with cancer-related pain should be treated with strong opioids as soon as the non-opioid analgesics become ineffective [1]. If pain relief and improved functionality are not demonstrated, other types of medication should be considered along with alternative analgesics to achieve patient-specific pain goals. Opioid rotation is Anecdotal reports have shown that multiple opioids are often simultaneously administered for different reasons [6], other than the obvious disparity in effecting different receptor subgroups and specificity. In a randomized study [7], the rescue morphine consumption was much higher
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