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

Abstract

Opioid switching is a common practice of substituting one opioid for another to improve analgesia or adverse effects; however, it has limited evidence. This study aimed to examine the effectiveness of opioid switching in advanced cancer. This multi-center prospective cohort study recruited patients assessed to switch opioids (opioid switch group) or to continue ongoing opioid treatment (control group). Clinical data (demographics, opioids) and validated instruments (pain and adverse effects) were collected over two timepoints seven days apart. Descriptive analyses were utilized. Non-parametric tests were used to determine differences. Fifty-four participants were recruited (23 control group, 31 switch group). At the follow-up, opioid switching reduced pain (worst, average, and now) (p < 0.05), uncontrolled breakthrough pain (3-fold reduction, p = 0.008), and psychological distress (48% to 16%, p < 0.005). The switch group had a ≥25% reduction in the reported frequency of seven moderate-to-severe adverse effects (score ≥ 4), compared to a reduction in only one adverse effect in the control group. The control group experienced no significant pain differences at the follow-up. Opioid switching is effective at reducing pain, adverse effects, and psychological distress in a population with advanced cancer pain, to levels of satisfactory symptom control in most patients within 1 week.

Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits

“…Opioid rotation, defined as switching from one opioid to another or changing the route of opioid administration, should optimize pain management. 76 – 79 …”

“…Opioid rotation, defined as switching from one opioid to another or changing the route of opioid administration, should optimize pain management. [76][77][78][79] It is imperative to improve background analgesia, which is a prerequisite for the diagnosis of BTcP. 41 Furthermore, optimization of the analgesic regimen for background pain results in a reduction in the number, intensity and duration of BTcP.…”