Why is opioid rotation considered in the treatment of pain?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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  • Of cancer patients receiving active cancer treatment, 33% experience severe pain but 30% do not receive adequate pain treatment.

  • Opioids do not have a ceiling effect or uniform plasma levels, so individual titration required.

  • Intolerable side effects along with inadequate analgesia contribute in 10-30% of patients treated with oral morphine for pain.

  • After initiation and titration, the initial clinical efficacy may gradually decline. Then higher doses may have undesirable side-effects, and rotation can be considered.

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