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

Jesús González-Barboteo, MD, Xavier Gómez-Batiste Alentorn, MD, PhD, Felipe A. Calvo Manuel, MD, PhD, Vicente Alberola Candel, MD, M. Amalia Palacios Eito, MD, Isabel Sánchez-Magro, MD, PhD, F. Javier Pérez Martín, PhD, Josep Porta-Sales, MD, PhD


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.


analgesics, opioid/administration and dosage, pain, neoplasms

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