title: Opioid rotation versus combination for cancer patients with chronic uncontrolled pain: a randomized study.
abstract: BACKGROUND
  For cancer patients with inadequate pain relief, a switch to an alternative opioid is the preferred option for symptomatic improvement. However, multiple opioids are often simultaneously administered for anecdotal reasons. This prospective study evaluated pain response to either opioid rotation or combination in patients with uncontrolled cancer pain.
  
  
  METHODS
  Patients suffering with uncontrolled cancer pain despite dose titration were randomly assigned to opioid rotation group or opioid combination group. Patients answered a questionnaire that included items on pain severity (0 to 10) and interferences at baseline and after one week.
  
  
  RESULTS
  Of the 50 patients registered, 39 patients answered the questionnaire after one week of treatment. After one week, the mean pain scores were significantly improved in both groups. Ten patients (42%) in the rotation group and 16 patients (62%) in the combination group reported that they achieved relief from pain (p = 0.08). The incidence of adverse events was similar in both groups, but fewer patients experienced constipation with opioid rotation than with combination (17% vs. 42%, respectively; p = 0.05). The frequency of rescue analgesics (50% vs. 69%; p = 0.17) and dose modification (29% vs. 38%; p = 0.49) were similar in the rotation and combination groups.
  
  
  CONCLUSIONS
  For patients with chronic uncontrolled cancer pain, both opioid rotation and combination strategies appear to provide significant relief of pain and improved patient satisfaction.
  
  
  BACKGROUND
  This study was registered in advance to ClinicalTrials.gov (no. NCT00478101).
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University, Chungju, South Korea. suraci1000@naver.com.
authors.forename: Hyun-Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea. zoomboom@hanmail.net.
authors.forename: Young Saing
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Medicine, Sungkyunkwan University Samsung Medical Center, 135-710, Seoul, South Korea. hematoma@skku.edu.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D059350:Chronic Pain / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid