Opioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study.
J Palliat Med
; 27(3): 388-393, 2024 Mar.
Article
in En
| MEDLINE
| ID: mdl-37955655
ABSTRACT
Background:
Opioid switching is common, however, conversion tables have limitations. Guidelines suggest postswitch dose reduction, yet, observations show opioid doses may increase postswitch.Objectives:
To document the opioid conversion factor postswitch in cancer, and whether pain and adverse effect outcomes differ between switched opioid groups. Design/Setting:
This multicenter prospective longitudinal study included people with advanced cancer in Australia. Clinical data (demographics, opioids) and validated instruments (pain, adverse effects) were collected twice, seven days apart.Results:
Opioid switch resulted in dose increase (median oral morphine equivalent daily dose 90 mg [interquartile range {IQR} 45-184] to 150 mg [IQR 79-270]), reduced average pain (5.1 [standard deviation {SD} 1.7] to 3.8 [SD 1.6]), and reduced adverse effects. Hydromorphone dose increased 2.5 times (IQR 1.0-3.6) above the original conversion factor used.Conclusions:
Opioid switching resulted in overall dose increase, particularly when switching to hydromorphone. Higher preswitch dosing may require higher dose conversion ratios. Dose reduction postswitch risks undertreatment and may not be always appropriate.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Chronic Pain
/
Cancer Pain
/
Neoplasms
Limits:
Humans
Language:
En
Journal:
J Palliat Med
Journal subject:
SERVICOS DE SAUDE
Year:
2024
Document type:
Article
Affiliation country:
Australia
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA