Opioid rotation versus combination for cancer patients with chronic uncontrolled pain: a randomized study

Hyun-Jun Kim, Young Saing Kim, Se Hoon Park, Hyun-Jun Kim, Young Saing Kim, Se Hoon Park

Abstract

Background: For 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.

Methods: Patients 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.

Results: Of 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.

Conclusions: For patients with chronic uncontrolled cancer pain, both opioid rotation and combination strategies appear to provide significant relief of pain and improved patient satisfaction.

Trial registration: This study was registered in advance to ClinicalTrials.gov (no. NCT00478101).

Figures

Fig. 1
Fig. 1
Changes in the pain scores

References

    1. Marinangeli F, Ciccozzi A, Leonardis M, Aloisio L, Mazzei A, Paladini A, et al. Use of strong opioids in advanced cancer pain: a randomized trial. J Pain Symptom Manage. 2004;27(5):409–416. doi: 10.1016/j.jpainsymman.2003.10.006.
    1. Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre study of cancer pain and its treatment in France. BMJ. 1995;310(6986):1034–1037. doi: 10.1136/bmj.310.6986.1034.
    1. Anderson KO, Mendoza TR, Valero V, Richman SP, Russell C, Hurley J, et al. Minority cancer patients and their providers: pain management attitudes and practice. Cancer. 2000;88(8):1929–1938. doi: 10.1002/(SICI)1097-0142(20000415)88:8<1929::AID-CNCR23>;2-2.
    1. Mercadante S. Opioid rotation for cancer pain: rationale and clinical aspects. Cancer. 1999;86(9):1856–1866. doi: 10.1002/(SICI)1097-0142(19991101)86:9<1856::AID-CNCR30>;2-G.
    1. Indelicato RA, Portenoy RK. Opioid rotation in the management of refractory cancer pain. J Clin Oncol. 2002;20(1):348–352.
    1. Chung NADM, Kim JS, Yang KM. Current status of symptom and pain control in cancer patients treated with chemotherapy. Korean J Hospice Palliat Care. 2003;6(2):144–151.
    1. Lauretti GR, Oliveira GM, Pereira NL. Comparison of sustained-release morphine with sustained-release oxycodone in advanced cancer patients. Br J Cancer. 2003;89(11):2027–2030. doi: 10.1038/sj.bjc.6601365.
    1. Southam MA. Transdermal fentanyl therapy: system design, pharmacokinetics and efficacy. Anticancer Drugs. 1995;6(Suppl 3):29–34. doi: 10.1097/00001813-199504003-00005.
    1. Korte W, de Stoutz N, Morant R. Day-to-day titration to initiate transdermal fentanyl in patients with cancer pain: short- and long-term experiences in a prospective study of 39 patients. J Pain Symptom Manage. 1996;11(3):139–146. doi: 10.1016/0885-3924(95)00162-X.
    1. Tawfik MO, Bryuzgin V, Kourteva G. Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain. Curr Med Res Opin. 2004;20(3):259–267. doi: 10.1185/030079903125003026.
    1. Morita T, Takigawa C, Onishi H, Tajima T, Tani K, Matsubara T, et al. Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial. J Pain Symptom Manage. 2005;30(1):96–103. doi: 10.1016/j.jpainsymman.2004.12.010.
    1. Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage. 2001;21(5):397–406. doi: 10.1016/S0885-3924(01)00271-8.
    1. Yun YH, Mendoza TR, Heo DS, Yoo T, Heo BY, Park HA, et al. Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory. Oncology. 2004;66(6):439–444. doi: 10.1159/000079497.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–158. doi: 10.1016/S0304-3959(01)00349-9.
    1. Wall PD, Melzack R. Textbook of Pain. 4. New York: Churchill Livingstone; 1999.
    1. Loeser JD, Butler SH, Chapman CR, Turk DC. Bonica's Management of Pain. 3. Philadelphia: Lippincott Williams & Wilkins; 2001.
    1. Ross FB, Wallis SC, Smith MT. Co-administration of sub-antinociceptive doses of oxycodone and morphine produces marked antinociceptive synergy with reduced CNS side-effects in rats. Pain. 2000;84(2–3):421–428. doi: 10.1016/S0304-3959(99)00230-4.
    1. Niv D, Nemirovsky A, Rudick V, Geller E, Urca G. Antinociception induced by simultaneous intrathecal and intraperitoneal administration of low doses of morphine. Anesth Analg. 1995;80(5):886–889.
    1. Pick CG, Roques B, Gacel G, Pasternak GW. Supraspinal mu 2-opioid receptors mediate spinal/supraspinal morphine synergy. Eur J Pharmacol. 1992;220(2–3):275–277. doi: 10.1016/0014-2999(92)90761-R.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit