title: Managing cancer pain and symptoms of outpatients by rotation to sustained-release hydromorphone: a prospective clinical trial.
abstract: OBJECTIVE
  In this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain.
  
  
  METHODS
  Before and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, chi).
  
  
  RESULTS
  Rotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.
  
  
  CONCLUSIONS
  Switching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact.
authors.affiliation: Clinic for Anesthesiology and Intensive Care Medicine, Pain Clinic Department, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany. s.wirz@web.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirz
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Wartenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Elsen
authors.forename: Maria
authors.initials: M
authors.lastname: Wittmann
authors.forename: Marta
authors.initials: M
authors.lastname: Diederichs
authors.forename: Joachim
authors.initials: J
authors.lastname: Nadstawek
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D004091:Hydromorphone