Opioid rotation in chronic noncancer pain

Opioid rotation (OR) or switching is a therapeutic technique where the type of opioid or route of administration is changed in order to reduce adverse effects and/ or improve analgesic efficacy, in other words to open up a therapeutic window.

The concept of OR is based largely on research and clinical experience in the treatment of cancer pain; however, the technique may also be of benefit in CNCP127 or acute pain management.128 However, according to a Cochrane review, OR is still not practiced commonly if there are problems with opioid therapy in CNCP.129[I] In a prospective review of patients commencing opioids for CNCP, the rates of OR at six months were 10.6 percent (controlled-release oxycodone), 19 percent (transdermal fentanyl), and 26.0 percent (controlled-release morphine sulfate), respectively.130

The rationale for OR is based on the variability of opioids in their effects, both between and within patients, a concept known as "incomplete cross-tolerance.''131 Such variability in opioid effects is due to the following factors.

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