Opioid Switching to Alternative Strong Opioids in Cancer Patients Experiencing Severe Pain
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- Category: Vol. 84, September 2016
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Opioid Switching to Alternative Strong Opioids in Cancer Patients Experiencing Severe Pain, MOHAMED A. MOUSA, MOHAMED M. EL-WASEEF, KHALED A.E. MOUSTAFA and SALAH EL-DIN A. IBRAHIM
Abstract
Background: Cancer is a public health problem and major cause of death worldwide. Pain is one of the most common and feared symptoms with marked impact on quality of life. According to the-WHO analgesic ladder, opioids are the mainstay of cancer pain management.
Oral morphine has been used in treating cancer pain of moderate to severe intensity. However, a significant proportion-of patients under oral morphine do not have successful outcomes, often switched to alternative strong opioids. Opioid rotation is a therapeutic maneuver aiming in improving anal-gesic response.
Opioid rotation be useful in opening the therapeutic window and have a more advantageous analgesia/toxicity relationship. However, too much work is to be done to further individualize analgesic therapy for patients with cancer. This work was planned to compare opioid shifting results from morphine to hydromorphone, oxycodone and fentanyl regard-ing analgesia in cancer pain patients.
Patients and Methods: The patients who were under the effect of basal controlled dose of sustained release MST tablets will be chosen from the study. They were under the effects of controlled treatment for 4 weeks or more. After that the cases of patients who would demonstrate severe pain experi-ence (VAS>7) despite controlled treatment would be picked up from the study for further investigation. For statistical purpose we chosed 390 cases for our study.
The patients divided in 3 main groups; each group consists of 130 patients:
•Group 1-switchers to oxycodone (130 patients) (in the form of tablets).
•Group 2-switchers to hydromorphone (130 patients) (in the form of tablets).
•Group 3-switchers to fentanyl (130 patients) (in the form of patches).
The control value of each patient will be his situation at the time of shifting.
Results: Regarding mean VAS significant improvement for patients switched to oxycodone versus VAS post 1 week in comparable to fentanyl versus post 1week and in comparable to hydromorphone versus mean VAS post 1 week. Also, significant improvement for patients switched to oxycodone versus VAS post 2 week in comparable to fentanyl versus post 2 week and in comparable to hydromorphone versus VAS post 2 week. Lastly, significant improvement for patients switched to oxycodone versus mean VAS post 4 week in comparable to fentanyl versus mean VAS post 4 week and in comparable to hydromorphone versus mean VAS post 4 week.
Conclusion: In this study, we conclude that patients switched to oxycodone improved score of pain.