Promoting science in a pragmatic world: not (yet) time for partial opioid rotation

Excerpt

For managing cancer pain, elaborated recommendations are available about the screening of pain intensity, the WHO ladder, a Cochrane review [22] and the European Association of Palliative Care (EAPC) recommendations of opioid analgesics [11], managing side effects of morphine (EAPC recommendations) [5] including opioid rotation [12], and stepwise approaches on how to integrate disease-directed treatments (radio- and chemotherapy) and neurolytic or neuraxial interventions [4]. However, we do not manage pain but rather assess, treat, and accompany patients [4] who suffer from various—often coexisting and fluctuating—pain syndromes [3], have risk factors for increased pain expression (incident or neuropathic pain, psychoexistential suffering, and a history of substance abuse) [7] requiring palliation of both pain and suffering [21], or need different interacting medications (even with restrictive nonpolypharmacy) for multidimensional symptom control. We also learned how to assess the impact of pain on patients’ function and involved family members, leading into the development of educational interventions [16]. With all these written and compassionately taught (best practice) recommendations, the majority of patients experience a satisfactory symptom control of pain syndromes, judged not only by pain intensity, but also by physical, social, and emotional function. …