How are equianalgesic dose tables used in the management of opioids for pain?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Equianalgesic dose tables

  • Opioid dose requirements can vary in the clinical setting as much as 40-fold.

  • Equianalgesic dose defined as the dose in steady state providing the same analgesic response. This has been standardized to 10 mg of parental morphine in most studies.

  • First equianalgesic dose table published more than 40 years ago, and remain with little variation.

  • Items that may influence relative potencies:

    • Major organ dysfunction, particularly renal and hepatic impairment, but also adrenal insufficiency, hypothyroidism, and abnormal levels of protein binding

    • Demography, including race, age, and gender

    • Most trials were short term trials of acute postoperative pain or in cancer pain with low dose opioids

    • All new treatment should be considered a trial until it is found to be analgesically effective with acceptable side-effect profile.

    • No evidence-based guidelines for opioid choices with rotation.

    • Rotation in cancer patients regains satisfactory pain control and/or reduced side effects in 50-70% of patients.

    • In cancer population, 80% of patients required one switch, 44% 2 or more, 20% 3 or more.

Conversion from oral or transdermal to parenteral route results in more rapid analgesic effects. In cancer patients this is successful 75-95% of the time.

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