High opioid dosage rapid detoxification of cancer patient in palliative care with the Raffaeli model.

Abstract

BACKGROUND:

Chronic opioid administration can induce adverse drug-dependent events and tolerance and/or hyperalgesia development. Opioid rotation is the treatment option in this case; however, it can expose patients to long periods of ineffectiveness and/or development of withdrawal syndrome, overdose, or adverse events. To overcome this issue, a method of rapid detoxification from opioids has been developed.

AIMS:

To assess feasibility and efficacy of our opioid detoxification protocol in patients affected from chronic cancer pain. SETTINGS/PATIENTS: We studied 15 patients, with chronic cancer pain, who were afferent to Hospice of Rimini, Italy, were in therapy with high doses of opioid and needed opioid rotation or a therapeutic variation because of opioid toxicity, inefficacy, tolerance, or hyperalgesia. Each patient received a fixed dose of endovenous morphine and clonidine plus oral ketoprofen or ibuprofen, and oral lorazepam, if required, for at least 3 days, suspending the previous opioid therapy. We monitored withdrawal symptoms, pain intensity, type, and intensity of adverse events.

RESULTS:

Withdrawal symptoms were experienced by four (26.6 percent) patients. The average Numerical Rating Scale for pain decreased significantly (p < 0.05) from 8.3 ± 1.57 to 3.6 ± 1.4 at the end of the detoxification and to 2.4 ± 1 at the end of the rotation or therapeutic adjustment. Average duration of the detoxification was 6.86 ± 6.4 days (range 3-22).

CONCLUSIONS:

The results suggested that the detoxification protocol may be effective in preventing withdrawal signs in patients needing a therapeutic change because of opioid-induced tolerance, hyperalgesia, or toxicity.

• Authors: Maria Cristina Monterubbianesi, Jenny Capuccini, Isabella Ferioli, Davide Tassinari, Donatella Sarti, William Raffaeli
• Journal: Journal of opioid management (J Opioid Manag) 2012 Sep-Oct Vol. 8 Issue 5 Pg. 292-8 ISSN: 1551-7489 [Print] United States
• PMID: 23247906 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid

Topics

• Aged
• Analgesics, Opioid (administration & dosage, adverse effects)
• Chronic Pain (drug therapy)
• Drug Tolerance
• Female
• Humans
• Inactivation, Metabolic
• Male
• Middle Aged
• Neoplasms (physiopathology)
• Palliative Care
• Retrospective Studies
• Substance Withdrawal Syndrome (prevention & control)