Opioid switching in cancer pain: From the beginning to nowadays

•Opioid therapy in cancer patients should be highly individualized.•Opioid switching may allow to establish a more advantageous analgesia/toxicity relationship.•Indications for opioid switching require different modalities of intervention.•The knowledge of opioid pharmacology is of paramount importa...

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Published in:Critical reviews in oncology/hematology Vol. 99; pp. 241 - 248
Main Authors: Mercadante, Sebastiano, Bruera, Eduardo
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ireland Ltd 01.03.2016
Subjects:
Analgesics, Opioid - therapeutic use
Cancer pain
Hematology, Oncology and Palliative Medicine
Humans
Neoplasms - complications
Neoplasms - therapy
Opioid rotation
Opioid switching
Pain - drug therapy
Pain - etiology
Palliative Care
Opioid switching
Cancer pain
Opioid rotation
ISSN:1040-8428, 1879-0461, 1879-0461
Online Access:Get full text
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Summary:•Opioid therapy in cancer patients should be highly individualized.•Opioid switching may allow to establish a more advantageous analgesia/toxicity relationship.•Indications for opioid switching require different modalities of intervention.•The knowledge of opioid pharmacology is of paramount importance.•Opioid switching requires meticulous monitoring, particularly when using high doses of opioids. Opioid switching is the process of changing from one opioid to another to obtain a satisfactory clinical balance between analgesia and adverse effects. This pharmacological technique has been introduced about 20 years ago to enhance the opioid response in advanced cancer patients with chronic pain. More information is now available. This review will examine many different aspects of opioid switching, including the history and evolution through the last decades, some clinical aspects based on the most recent experience, controversies on the indications, conversion ratios and modalities of switching in some specific circumstances, and evidence based recommendations.
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ISSN:1040-8428
1879-0461
1879-0461
DOI:10.1016/j.critrevonc.2015.12.011