Die Opioidrotation in der Schmerztherapie

Abstract

The use of opioids in the treatment of chronic pain is sometimes accompanied by inadequate pain relief and opioid-specific side-effects. Opioid rotation is a therapeutic approach, that can improve analgesia and provide a more advantageous analgesia and toxicity relationship. This article presents a case report and discusses the mechanisms, indications and possibilities of opioid rotation.

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

“…oxycodone when cognitive side effects predominate, hydromorphone in renal insufficiency, fentanyl in patients with severe constipation or levomethadone in refractory neuropathic pain) this should be shown to be clinically relevant (Mercadante and Portenoy, 2001a). Opioid switch resulted in a reduction of side effects or pain intensity with lower doses than expected in comparison with the baseline opioid (De Stoutz et al, 1995; Kefalianakis et al, 2002). In this study also lower dosages were used in the group of “true” switches compared to patients with changes of the administration route, but better efficacy could not be attributed to a specific opioid.…”

“…If patients with problems on one opioid are switched to another many symptoms appear to improve irrespectively of the direction of the switch (Guindon et al, 2001; Lee et al, 2001; McNamara, 2002; Mercadante et al, 2001). The majority of papers deal with case reports or retrospective analyses of patients with cancer pain (Bruera et al, 1996; De Stoutz et al, 1995; Kefalianakis et al, 2002; Kloke et al, 2000; Müller‐Busch et al, 2002) or non‐cancer pain (Thomsen et al, 1999). The comparison of these studies is limited by the lack of a widely accepted staging system for cancer pain and by the differing approaches to opioid rotation that are used in different clinical settings (Ashby et al, 1999).…”