Opioid rotation in chronic non‐malignant pain patients

Abstract

Opioid rotations between different LAO resulted in better pain control and fewer side-effects at dose levels predicted to be equianalgesic. The majority of the patients rotated from SAO to LAO obtained improved analgesia, but the cost was a 74% increase in the opioid dose.

Practical Considerations for the Use of Tapentadol Prolonged Release for the Management of Severe Chronic Pain

“…Withdrawal symptoms on opioid switching are relatively common, and the rates of withdrawal observed on switching from a previous WHO step III opioid to tapentadol PR in these 2 studies 45,67 are notably lower than those observed in a study of patients with chronic nonmalignant pain who were switched from one strong opioid to another. 68 In that study, 68 the rate of withdrawal was 32% for patients switching from one PR opioid to another and 44% for patients switching from an immediate-release (IR) opioid to a PR opioid. 68 Withdrawal symptoms occurring on opioid switching may be addressed by coadministration of another opioid analgesic, preferably the IR formulation of the previous opioid.…”

“…68 In that study, 68 the rate of withdrawal was 32% for patients switching from one PR opioid to another and 44% for patients switching from an immediate-release (IR) opioid to a PR opioid. 68 Withdrawal symptoms occurring on opioid switching may be addressed by coadministration of another opioid analgesic, preferably the IR formulation of the previous opioid. 63 For concomitant use of IR opioids with tapentadol PR for breakthrough pain, please refer to the "Concomitant Analgesics and Coanalgesics" subsection later herein.…”

Tapentadol Prolonged Release Versus Strong Opioids for Severe, Chronic Low Back Pain: Results of an Open-Label, Phase 3b Study

“…In a study of patients with chronic, nonmalignant pain, the rate of withdrawal was 32% for patients switching from one PR opioid to another and 44% for patients switching from an IR opioid to a PR opioid [39]. There is a lack of strong evidence related to opioid switching, particularly with respect to adequate equipotency data [37,38].…”

Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders

“…The main reason appears to be that each mu opioid acts more strongly at certain mu subreceptors and more weakly at others, and people differ genetically in the proportions of the various subreceptors present in their systems (Mercadante, 1999; Pasternak, 2005; Thomsen, Becker, and Eriksen, 1999). …”