Hyperalgesia and opioid switching

@article{Mercadante2005HyperalgesiaAO,
  title={Hyperalgesia and opioid switching},
  author={Sebastiano Mercadante and Edoardo Arcuri},
  journal={American Journal of Hospice and Palliative Medicine},
  year={2005},
  volume={22},
  pages={291 - 294}
}
  • S. MercadanteE. Arcuri
  • Published 1 July 2005
  • Medicine, Psychology
  • American Journal of Hospice and Palliative Medicine
Opioids, intended to abolish pain, can unexpectedly produce hyperalgesia, particularly during rapid opioid escalation. Opioid switching could be a therapeutic option in a condition of opioid-induced tolerance or hyperalgesia, but conversion ratios between opioids are difficult to apply in this context and require strict surveillance and expertise. This situation is challenging, because the rapid escalation of opioid doses, possibly due to the development of opioid-induced tolerance, can cause… 

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References

SHOWING 1-10 OF 23 REFERENCES

Hyperalgesia: an emerging iatrogenic syndrome.

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study.

In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option, and higher doses of methad one are necessary with respect to the equianalgesic calculated dose ratios previously published.

Methadone titration in opioid-resistant cancer pain.

This method of methadone titration often results in improved pain control in patients with morphine resistance or intolerance, and requires careful titration in a specialist inpatient unit as there is no reliable formula for dose equivalence.

Rapid switching from morphine to methadone in cancer patients with poor response to morphine.

A rapid substitution of morphine with methadone using an initial fixed ratio of 5:1 is a safe and effective method for improving the balance between analgesia and adverse effects in cancer patients with poor morphine response.

Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio?

The results of this study confirm that methadone is a potent opioid, more potent than believed, especially in patients who are tolerant to high doses of opioids.

Opioid use in cancer pain. Is a more liberal approach enhancing toxicity?

Identification of risk factors for the development of OIN can help in its prevention and improve the quality of life in advanced cancer patients, and strategies for its treatment can be implemented with encouraging results.