section name header

Evidence summaries

Opioid Switching to Improve Pain Relief and Drug Tolerability

For patients with inadequate pain relief and intolerable adverse effects when using an opioid for chronic pain, a switch to an alternative opioid may be an effective option although there is no evidence from controlled trials. Level of evidence: "C"

A Cochrane review [Abstract] 1 [withdrawn from publication] summarises the evidence on opioid switching. Significant minority of patients with chronic pain requiring strong opioids either suffer intolerable side-effects, inadequate pain relief, or both. For these patients switching to an alternative opioid is becoming established clinical practice. Fifty-two uncontrolled studies were identified, comprising 23 case reports, 15 retrospective studies/audits and 14 prospective uncontrolled studies. The majority of the reports used morphine as first-line opioid and the most frequently used second-line opioid was methadone. All reports, apart from one, concluded that opioid switching is a useful clinical manoeuvre for improving pain control and/or reducing opioid-related side-effects. It is unclear whether the improved outcome post-switch is a true drug effect, or merely improved tolerability as a result of dose reduction. Bias towards reporting only positive findings is obvious.

References

  • Quigley C. WITHDRAWN: Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev 2013;(10):CD004847. [PubMed]

Primary/Secondary Keywords