Declan Walsh, MSC, FACP

Opioid rotation involves changing from one opioid to another using
correct equianalgesic conversion techniques to achieve better analgesia
and/or fewer side effects. The strategy appears to work because of
significant interindividual variations in response to both analgesic activity
and toxicity. Although there are many retrospective studies, few
prospective controlled trials of opioid rotation have been published.
The practical and theoretical advantages of opioid rotation include
improved analgesia, reduced side effects, cost reduction, and improved
compliance. Disadvantages include problems related to inaccurate conversion
tables, limited availability of certain opioid formulations, drug
interactions, and the possibility of increased expense. Weighing the
advantages and disadvantages is essential prior to making a decision
about opioid rotation selection.

Many individuals with advanced malignancy continue to suffer
from pain and, consequently, impaired quality of life. The clinical
scenarios in advanced cancer pain are complex, and successful management
may require a more sophisticated and individualized approach
than suggested by the World Health Organization guidelines.
In patients referred to the Harry R. Horvitz Center for Palliative
Medicine in Cleveland, numerous commonly occurring errors in
opioid use have been noted. This article describes these errors and
offers strategies with which to improve outcomes for patients suffering
with cancer pain.