Effectiveness of opioid rotation in the control of cancer pain: The ROTODOL Study

Abstract

Objective: To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR. Setting: Thirty-nine tertiary hospital services.Patients: Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics.Intervention: Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (NRS) of 0-10. Average pain (AP) intensity in the last 24 hours, breakthrough pain (BTP), and the number of episodes of BTP on the days before and 1 week after OR were assessed. The pre-OR and post-OR opioid were recorded. The presence and intensity of any AEs occurring after OR were also recorded.Results: In the 67 patients evaluated, 75 ORs were recorded. In all cases, the main reason for OR was poor pain control. Pain intensity decreased by ≥2 points after OR in 75.4 percent and 57.8 percent of cases for AP and BTP, respectively. If the initial NRS score was ≥4, a decrease below 4 accounted for 50.9 percent and 32.3 percent of cases for AP and BTP, respectively. The number of episodes of BTP also decreased significantly (p 0.001). A total of 107 AEs were reported, most of which were mild in intensity, with gastrointestinal symptoms predominating.Conclusions: Opioid rotation appears to be both safe and effective in the management of basal and breakthrough cancer pain.