Opioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study

Wong, AK; Klepstad, P; Rubio, JP; Somogyi, AA; Vogrin, S; Le, B; Philip, J

Author(s): Wong, AK; Klepstad, P; Rubio, JP; Somogyi, AA; Vogrin, S; Le, B; Philip, J;
Details: Publication Year 2024-03,Volume 27,Issue #3,Page 388-393
Journal Title: Journal of Palliative Medicine
Publication Type: Research article
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.
Publisher: Mary Ann Liebert
Keywords: Humans; Analgesics, Opioid; Hydromorphone/adverse effects; *Cancer Pain/drug therapy; Prospective Studies; Longitudinal Studies; *Chronic Pain/drug therapy; *Neoplasms/drug therapy; advanced cancer; analgesics; opioid; palliative care
Department(s): Palliative Care
Publisher's Version: https://doi.org/10.1089/jpm.2023.0541
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-05-07 04:39:17

Last Modified: 2024-05-07 04:39:59