Background Although being a controversal debated, opioids may be an alternative therapeutic in intractable rheumatologic non-malignant pain (RNMP). Different mecanisms including receptor activity, cross over tolerance and toxic metabolits can explaine the differences in analgesic or adverse effect responses among opioids.
Objectives To determinated that rotation with oral morphine to oral hydromorphone can be useful for establishing a more advantages analgesia/toxicity relationship.
Methods We made retrospectivly 24 rotations in patients suffering from RNMP. Different criteria were assessed: dose of morphine and hydromorphone (mg/day), duration of treatment (days), evaluation of pain using a Visual Analogic Scale (VAS, cm) before and after rotation, and finally the causes of rotation.
Results 11 rotations were made for nausea and 13 for inefficacity. There is a significant statistical decrease of VAS after rotation (test of Student).
Conclusion Oral hydromorphone appeared to result in improvement of pain relief after rotation, and may provide a suitable alternative to bypass nausea. We observed an average morphine/hydromorphone ratio of 7:1, which has become the accepted standard.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.