Opioid rotation in the treatment of joint pain. A review of 67 cases

Objective. To determine that opioid rotation can be useful for establishing a more advantageous analgesia/toxicity relationship in rheumatologic pain. Methods. Among patients treated with opioids for rheumatologic non-malignant pain, 67 patients with opioid rotation were enrolled retrospectively. In...

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Bibliographic Details
Published in:Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2002-10, Vol.69 (5), p.491-494
Main Authors: Grilo, R.M, Bertin, P, Scotto di Fazano, C, Coyral, D, Bonnet, C, Vergne, P, Trèves, R
Format: Article
Language:English
Subjects:
Administration, Cutaneous
Administration, Oral
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Buprenorphine - administration & dosage
Buprenorphine - therapeutic use
Drug Administration Schedule
Fentanyl - administration & dosage
Fentanyl - therapeutic use
Humans
Hydromorphone - administration & dosage
Hydromorphone - therapeutic use
Joints - physiopathology
Morphine - administration & dosage
Morphine - therapeutic use
non-malignant pain
opioid rotation
Pain - etiology
Pain - physiopathology
Pain - prevention & control
Pain Measurement
Retrospective Studies
Rheumatic Diseases - complications
Rheumatic Diseases - drug therapy
rheumatology
Rheumatology - methods
Treatment Outcome
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Summary:Objective. To determine that opioid rotation can be useful for establishing a more advantageous analgesia/toxicity relationship in rheumatologic pain. Methods. Among patients treated with opioids for rheumatologic non-malignant pain, 67 patients with opioid rotation were enrolled retrospectively. In all cases, the other analgesics had failed. The opioids used were: oral morphine, oral hydromorphone, oral buprenorphine and transdermal fentanyl. The reasons for rotation were noted and the improvement of pain was assessed by comparing baseline and post-treatment visual analog scales (VAS in mm). Results. The 67 patients suffered from low back pain with sciatica in 27 cases, inflammatory arthritis in 14 cases, brachial neuralgia in six cases, osteoarthritis in eight cases and miscellaneous in 12 cases. The opioid rotations were the substitution of morphine by transdermal fentanyl, by oral hydromorphone in most of the cases. The principal reason for opioid rotation was failure of the first treatment. The mean of VAS improvement was 30 mm ( P 
ISSN:1297-319X
DOI:10.1016/S1297-319X(02)00435-9