Reddy, A., Yennurajalingam, S., Pulivarthi, K., Palla, S.L., Wang, X., Kwon, J.H., . . . Bruera, E. (2013). Frequency, outcome, and predictors of success within 6 weeks of an opioid rotation among outpatients with cancer receiving strong opioids. The Oncologist, 18, 212–220.

DOI Link

Study Purpose

To determine indications, results, and predictors of successful opioid rotation

Intervention Characteristics/Basic Study Process

Records of consecutive patients who received strong opioids and had follow-up data within six weeks of the initial clinic visit were reviewed and analyzed.

Sample Characteristics

  • N = 146 patients with six weeks of data; 114 had opioid rotation
  • MEDIAN AGE = 55 years
  • MALES: 60%, FEMALES: 40%
  • KEY DISEASE CHARACTERISTICS: Multiple tumor types
  • OTHER KEY SAMPLE CHARACTERISTICS: 71% Caucasian, 12% African American, 11 % Hispanic

Setting

  • SITE: Single site 
  • SETTING TYPE: Outpatient 
  • LOCATION: Texas

Phase of Care and Clinical Applications

  • APPLICATIONS: Palliative care

Study Design

  • Retrospective, descriptive

Measurement Instruments/Methods

  • Edmonton Symptom Assessment Scale
  • Symptom Distress Scale
  • Delirium Assessment Scale
  • Cut down, annoyed, guilty, eye-opener (CAGE) questionnaire

Results

Successful opioid rotation was defined as improvement in side effects if that was the reason for opioid rotation, or a 30% or 2-point reduction in pain if uncontrolled pain was the reason for opioid rotation. For 95% of patients, uncontrolled pain was the reason for opioid rotation. Sixty-five percent of patients had successful opioid rotation.  No difference was seen in success based on ethnic and demographic data. Scores for pain (p < .001), insomnia (p = .013), and depression (p = .04) were improved at follow-up, with no significant difference in morphine equivalents at follow-up.

Conclusions

Findings suggest that opioid rotation is successful in some patients for improvement in pain management.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)

 

Nursing Implications

Opioid rotation has been suggested in cases of uncontrolled pain for individuals on strong opioids, but little research has been done in this area. This study is purely descriptive, but does suggest that opioid rotation can be successful to improve pain control for some patients.