• Stefan Wirz, Hans Christian Wartenberg, Christian Elsen, Maria Wittmann, Marta Diederichs, and Joachim Nadstawek.
• Clinic for Anesthesiology and Intensive Care Medicine, Pain Clinic Department, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany. s.wirz@web.de
• Clin J Pain. 2006 Nov 1;22(9):770-5.

PurposeIn this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain.MethodsBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, chi).ResultsRotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.ConclusionsSwitching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact.

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