Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000400010
Brazilian Journal of Anesthesiology
Review Article

Uso e rotação de opioides para dor crônica não oncológica

Use and rotation of opioids in chronic non-oncologic pain

Durval Campos Kraychete; Rioko Kimiko Sakata

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Resumo

JUSTIFICATIVA E OBJETIVOS: Para o tratamento da dor crônica existe a possibilidade de uso prolongado de opioides. Os opioides são eficazes para praticamente todas as síndromes dolorosas crônicas não oncológicas, porém podem causar dependência. O objetivo deste texto é fazer uma revisão sobre o uso e rotação de opioides para dor crônica não oncológica. CONTEÚDO: O uso de opioides potentes é controverso e não são recomendados como medicamentos de primeira linha devido à possibilidade de dependência. Foi descrita tolerância, vício, fatores de risco para vício, rotação ou troca, regras gerais para administração, tabelas de conversão e dicas para prescrição de opioides. CONCLUSÕES: Os opioides são fármacos com eficácia comprovada para dor crônica não oncológica, porém sua prescrição deve ser feita respeitando alguns critérios para reduzir a incidência de efeitos adversos e vício.

Palavras-chave

ANALGÉSICOS, Opioides, efeitos adversos, DOR, Crônica

Abstract

BACKGROUND AND OBJECTIVES: Prolonged use of opioids is a possibility for chronic pain treatment. Opioids are effective for virtually all chronic non-cancer pain syndromes, but may cause dependence. The aim of this paper is to review the use and rotation of opioids in chronic non-oncologic pain. CONTENT: The use of potent opioids is controversial and not recommended as first-line drugs due to the possibility of dependence. The following topics are described: tolerance, addiction, risk factors for addiction, rotation or replacement, general administration rules, conversion tables, and tips for prescribing opioids. CONCLUSIONS: Opioids are drugs with proven efficacy for chronic non-oncologic pain, but its prescription should meet certain criteria in order to reduce the incidence of adverse effects and addiction.

Keywords

Chronic Pain, Analgesics, Opioid

References

Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev. 2004.

Trescot AM, Boswell MV, Atluri SL. Opioid Guidelines in the Management of Chronic Non-Cancer Pain. Pain Phys. 2006;9:1-40.

Furlan AD, Sandoval JA, Mailis-Gagnon A. Opioids for chronic pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174(11).

Vallerand AH. The use of long-acting opioids in chronic pain management. Nurs Clin North Am. 2003;38(3):435-445.

Allan L, Richarz U, Simpson K. Transdermal fentanyl versus release oral morphine in strong-opioid naive patients with chronic low back pain. Spine. 2005;30(22):2484-2490.

Solomon DH, Avom J, Wang PS. Presciption opioid use among older adults with arthritis or low back pain. Arthritis Rheum. 2006;55(1):35-41.

Colzzi F, Mattia C. Oxycodone: Pharmacological profile and clinical data inchronic pain managment. Min Anesthesiol. 2005;71(7-8):451-460.

Langford R, McKenna F, Ratcliffe S. Transdermal fentanyl for improvement of pain and functioning in osteoarthritis: A randomized, placebo-controlled trial. Arthitis Rheum. 2006;54(6):1829-1837.

Smith MT. Opioid-induced hyperalgesia, opioid rotation and opioid combinations. Acute Pain. 2008;10:199-200.

Tellioglu T. The use of urine drug testing to monitor patients receiving chronic opioid therapy for persistent pain conditions. Med Health R I. 2008;91(9):279-280,282.

Souter KJ, Fitzgibbon D. Equianalgesic dose guidelines for long-term opioid use: Theoretical and practical considerations. Sem Anesth Perioper Med Pain. 2004;23(4):271-280.

Anderson R, Saiers JH, Abram S. Accuracy in equianalgesic dosing: Conversion dilemmas. J Pain Symptom Manage. 2001;21(5):397-406.

Brant JM. Opioid equianalgesic conversion: the right dose. Clin J Oncol Nurs. 2001;5(4):163-165.

Caims R. The use of oxicodone in cancer-related pain: a literature review. Int J Palliat Nurs. 2001;7(11):522-527.

Gammaitoni AR, Fine P, alvarez N. Clinical application of opioid equianalgesic data. Clin J Pain. 2003;19(5):286-297.

Ginsberg B, Sinatra RS, Adler LJ. Conversion to oral controlled-release oxycodone from intravenous opioid analgesic in postoperative setting. Pain Med. 2003;4(1):31-38.

Boubekeur N, Delorme J, Roussel P. Échelle d'équivalences des antalgiques (EDEA): mise au point d'un outil pour la conversion équianalgésique. Douleurs. 2006;7(4):201-206.

Benítez-Rosario MA, Salinas-Martín A, Aguirre-Jaime A. Morphine-methadone opioid rotation in cancer patients: Analysis of Dose Ratio Predicting Factors. J Pain Symptom Manage. 2009;37(6):061-068.

Coluzzi F, Pappagallo M. Opioid therapy for chronic non-cancer pain: Practice guidelines for initiation and maintenance of therapy. Min Anestesiol. 2005;71:425-433.

Grilo RM, Bertin P, Scotto di Fazano C. Opioid rotation in the treatment of joint pain: A review of 67 cases. Joint Bone Spine. 2002;69:491-494.

Moryl N, Santiago-Palma J, Kornick C. Pitfalls of opioid rotation: substituting another opioid for methadone in patients with cancer pain. Pain. 2002;96:325-328.

Morita T, Takigawa C, Onishi H. Opioid Rotation from Morphine to fentanyl in Delirious Cancer Patients: An Open-Label Trial. J Pain Symptom Manage. 2005;30(1):96-103.

McNicol E, Horowicz-Mehler N, Fisk RA. Management of opioid side effects in cancer-related and chronic noncancer pain: A systematic review. J Pain. 2003;4:231-256.

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