Opioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study
Date
2024
Authors
Wong, A.K.
Klepstad, P.
Rubio, J.P.
Somogyi, A.A.
Vogrin, S.
Le, B.
Philip, J.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Journal of Palliative Medicine, 2024; 27(3):388-393
Statement of Responsibility
Aaron K. Wong, Pal Klepstad, Justin P. Rubio, Andrew A. Somogyi, Sara Vogrin, Brian Le, and Jennifer Philip
Conference Name
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.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
© Mary Ann Liebert, Inc.