Experiencia clínica en cambio de opioides en el tratamiento del dolor crónico no oncológico

F. J. López-Pérez; A. Mínguez-Martí; E. Vicario-Sánchez; A. Pastor-Clérigues; J. Sanfeliu-García; M. P. Ortega-García

doi:10.7399/fh.2014.38.5.7549

Experiencia clínica en cambio de opioides en el tratamiento del dolor crónico no oncológico

F. J. López-Pérez, A. Mínguez-Martí, E. Vicario-Sánchez, A. Pastor-Clérigues, J. Sanfeliu-García, M. P. Ortega-García

Resumen

Background: The implementation of opioid switch (OS) as a strategy in non-malignant chronic pain has been scarcely proved. This article aims to evaluate the results of OS in a Pain Treatment Unit. Methods: This is an observational retrospective study in which all patients who had been subjeted to OS for a period of 18 months were selected. All of them had been treated with opiods plus adyuvants for more than 6 months and had a visual analog scale (VAS) of at least 5, either with or without adverse effects. Two variables were defined: clinical improvement, as a reduction equal or superior to 3 in VAS or the elimination of two or more adverse effects; equianalgesic dose reduction is the difference between initial and final opioid dose. Results: 7 out of 9 (77%) patients showed clinical improvement. Median equianalgesic dose reduction was 37% (-72% +18%). Five patients (55%) presented adverse effects to opioids before the OS but only one (11%) after OS. Conclusions: OS was beneficial for the management of non-malignant chronic pain patients who have poor response to opioid treatment and/or with adverse effects. A secure OS should include a reduction in equianalgesic opioid dose. Prospective studys would achieve a mayor consensus for the applicance of OS in non-malignant chronic pain treatment.

Palabras clave

Chronic pain; Opioid switch; Opioid treatment

Texto completo:

PDF

Referencias

- Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169: 251-258.

- Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA. Comprehensive Review of Epi¬demiology, Scope, and Impact of Spinal Pain. Pain Physician. 2009; 12: E35-E70.

- Oscar A de Leon-Casasola. Opioids for chronic pain: new evidence, new strategies, safe prescribing. The American Journal of Medicine 126,S3-S11. 2013

- Ministerio de Sanidad, Política Social e Igualdad. Grupo de Expertos. Unidad de tratamiento de dolor: estándares y recomendaciones. Madrid: 2011.

- Sociedad Española del Dolor. Grupo de Opioides. Guía clínica de la utilización de opioides en dolor crónico no oncológico.

- Practice guidelines for chronic pain Management. American Society of Anesthesiologists task force on chronic pain and American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 112:810-33

- Vissers ZCP, Besse K, Hans G, Devulder J, Morlion B. Opioid rotation in the management of chronic pain: where is the evidence? Pain practice, Volume 10, Issue 2, 2010 85-93

- Tresco A, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, Jasper JF, Singh V, Jordan AE, Johnson BW, Cicala R, Dunbar E, Helm II S, Varley K, Suchdev PK, Swicegood JR, Calodney A, Ogoke BA, Stephen Minore W, Manchikanti L. Opioid Guidelines in the Management of Chronic Non-Cancer Pain Pain Physician. 2006;9:1-40 Actualización: Pain Physician 2008: Opioids Special Issue: 11:S5-S62

- Clifford Gevirtz. Opioid rotation: Methods and Cautions. Topics in Pain Management vol 27, nº10 May 2012

- Observatorio Regional de Cuidados Paliativos de Extremadura Guía Clínica Manejo de Opioides potentes para el dolor por cáncer en pacientes con enfermedad terminal. Septiembre 2011

- Roger Chou, Gilbert J. Fanciullo, Perry G. Fine, Jeremy A. Adler, Jane C. Ballantyne et al. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. The Journal of Pain. Volume 10, Issue 2:113-130, February 2009

- Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV. Opioid Rotation from High-dose morphine to transdermal buprenorphine in chronic pain patients. World Institute of Pain. 2007 Vol 7;2:123-129

- McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4:

–256.

- Narabayashi M, Saijo Y, Takenoshita S, et al. Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: an open-label trial. Jpn J Clin Oncol. 2008;38:296–304.

- Walker P, Palla S, Pei BL, Kaur G, Zhang K, Hanohano J, Munsell M, Bruera E. Switching from methadone to a different opioid: what is the equianalgesic dose ratio? Journal of Palliative Medicine 2008. Vol 11;8:1103-1108

- Houde R, Wallenstein S, Beaver W. Evaluation of analgesics in patients with cancer pain. Clin Pharm. 1966; 1: 59-97

- Beaver W, Feise GA. A comparison of the analgesic effect of intramuscular nalbuphine and morfine in patients with postoperative pain. J Pharmacol Exp Ther. 1978;204:487-496

- Perry G. Fine, Russell K. Portenoy, Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. Establishing “Best Practices” for Opioid Rotation: Conclusions of an Expert Panel Journal of Pain and Symptom Management 2009. Vol. 38;3: 418-425

- McPherson, Mary Lynn M. Demystifying opioid conversion calculations: aguide for effective dosing. 1st edition. American Society of Health System Pharmacists, Inc 2010. ISBN:978-1-58528-198-5

DOI: http://dx.doi.org/10.7399%2Ffh.2014.38.5.7549