This information can be derived from the equianalgesic dose, which is the dose of two opioids required to produce the same analgesic effect. There are a number of sources of information available to guide clinicians. The British National Formulary (BNF) publishes tables comparing a number of strong opioids with morphine.
2. 12 Whether, in fact, it is reasonable to extrapolate the outcomes of studies, for example from patients with cancer, to perioperative care without controlling for social and psychological distress has been questioned. The placebo effect does not seem to be simply a curious phenomenon noted in clinical studies; rather, it is likely to reflect some of the brain’s complex mechanisms for modulating pain. Pain is recognised as a multidimensional phenomenon.
The author declares that he does not have any conflict of interest.
There are a number of reasons why caution is raised alongside the publication of such tables, and these relate to patient factors and issues surrounding the information used to create the tables.
Physicians often find that the process of converting from one opioid agent to an equivalent dose of another agent, or changing the route of opioid administration challenging. This process is easiest to learn by using morphine as the reference standard. By following the steps listed below, the physician can safely convert from.
This can be easily done by using a 0 to 10 numeric rating scale, where 0 is equal to “lying in bed all day” and 10 is equal to “very active and able to do anything you want.” An individual's function should increase with improvement in pain control and vice-versa. It is also beneficial to assess functional improvements that follow medication changes. This provides an additional measure to monitor benefit of the medication.
amitriptyline, nortriptyline, desipramine) and anticonvulsants (e.g.
Inter-converting between oral and IV opioids is a very common situation encountered in clinical anesthesiology both in the context of treating acute perioperative pain, in the setting of chronic pain management or in combination. In order to determine equivalency between opioid agents, equianalgesic dosing tables are.
This data was derived from various randomized, controlled, clinical trials conducted in the 1950s and 1960s with typically a partial cross over design where morphine (IV or PO) was used as the standard for comparison in order to derive relative potency information. This data however has limitations as the study population primary included patients with acute post operative pain and that were relatively opiate naive which calls into question whether this data can truly be applied to populations on chronic and large doses of opioids.
Convert the calculated 24 hour equianalgesic dose of oral morphine to the 24 hour equianalgesic dose of the new opioid. Oxycodone is the preferred drug in this case as it is renally safer than morphine. Oxycodone is thought to be 1.5 times stronger than morphine. Therefore, Morphine sulfate 90mg is equianalgesic to.
Opioid Conversion Pre-Test General Guidelines Opioids Equivalency Table Equianalgesic Doses Land Mines Teaching Exercise 1: Converting from oral to parenteral morphine The Case Continues Teaching Exercise 2: Converting from oral morphine to fentanyl transdermal patch Opioid Conversion Tutorial Levy’s Rule Example 1 Example 2 Pearls Post test Resources Appendices How to institute opioid therapy Communication with patients and family on pain treatment Parenteral to oral conversion ratios of common opioids Facts about the fentanyl transdermal patch Using opioid infusions to palliate pain Author Physician Assisted Death: Real Stories Dr.
Multiple factors like inter- and intraindividual differences in opioid pharmacology may influence the accuracy of dose calculations, as does the heterogeneity of study design used to derive equianalgesic ratios. Equianalgesic tables should only serve as a general guideline to estimate equivalent opioid doses. Clinical.
Presented at the Annual Assembly of the American Academy of Hospice and Palliative Medicine, Orlando, FL, USA, February 6–9, 2005.
Equianalgesic tables should only serve as a general guideline to estimate equivalent opioid doses. We found inconsistent and variable equianalgesic ratios recommended for both opioid rotation and conversion. Current information in equianalgesic tables is confusing for physicians, and dangerous to the public. Clinical judgment should be used and individual patient characteristics considered when applying any table. Pain is one of the most common symptoms in cancer patients. Professional organizations and regulators should establish a rotation and conversion consensus concerning opioid equianalgesic ratios. Successful use of opioids to manage cancer pain requires adequate knowledge about opioid pharmacology and equianalgesia for the purpose of both drug rotation and route conversion. We surveyed commercially available educational materials in package inserts, teaching materials provided by pharmaceutical companies, and the Physicians' Desk Reference for equianalgesic tables of commonly used opioids. Opioids are widely prescribed for this and other purposes. The aim of this study was to demonstrate variations in equianalgesic ratios, as quoted in equianalgesic tables and various educational materials widely available to practicing physicians. Systematic research on equianalgesic opioid dose calculation is recommended to avoid adverse public health consequences of incorrect or inappropriate dosing. Multiple factors like inter- and intraindividual differences in opioid pharmacology may influence the accuracy of dose calculations, as does the heterogeneity of study design used to derive equianalgesic ratios. Properly used, they are safe, but they have serious and potentially lethal side effects.