• Maria Cristina Monterubbianesi, Jenny Capuccini, Isabella Ferioli, Davide Tassinari, Donatella Sarti, and William Raffaeli.
• Pain Therapy and Pallitive Care Unit, Infermi Hospital, Rimini, Italy.
• J Opioid Manag. 2012 Sep 1;8(5):292-8.

BackgroundChronic opioid administration can induce adverse drug-dependent events and tolerance and/or hyperalgesia development. Opioid rotation is the treatment option in this case; however, it can expose patients to long periods of ineffectiveness and/or development of withdrawal syndrome, overdose, or adverse events. To overcome this issue, a method of rapid detoxification from opioids has been developed.AimsTo assess feasibility and efficacy of our opioid detoxification protocol in patients affected from chronic cancer pain. SETTINGS/PATIENTS: We studied 15 patients, with chronic cancer pain, who were afferent to Hospice of Rimini, Italy, were in therapy with high doses of opioid and needed opioid rotation or a therapeutic variation because of opioid toxicity, inefficacy, tolerance, or hyperalgesia. Each patient received a fixed dose of endovenous morphine and clonidine plus oral ketoprofen or ibuprofen, and oral lorazepam, if required, for at least 3 days, suspending the previous opioid therapy. We monitored withdrawal symptoms, pain intensity, type, and intensity of adverse events.ResultsWithdrawal symptoms were experienced by four (26.6 percent) patients. The average Numerical Rating Scale for pain decreased significantly (p < 0.05) from 8.3 ± 1.57 to 3.6 ± 1.4 at the end of the detoxification and to 2.4 ± 1 at the end of the rotation or therapeutic adjustment. Average duration of the detoxification was 6.86 ± 6.4 days (range 3-22).ConclusionsThe results suggested that the detoxification protocol may be effective in preventing withdrawal signs in patients needing a therapeutic change because of opioid-induced tolerance, hyperalgesia, or toxicity.

20 keywords...

hide…