PMID- 25896106
OWN - NLM
STAT- MEDLINE
DCOM- 20161110
LR  - 20181202
IS  - 1873-6513 (Electronic)
IS  - 0885-3924 (Linking)
VI  - 50
IP  - 2
DP  - 2015 Aug
TI  - Methods of Rotation From Another Strong Opioid to Methadone for the Management of 
      Cancer Pain: A Systematic Review of the Available Evidence.
PG  - 248-59.e1
LID - S0885-3924(15)00175-X [pii]
LID - 10.1016/j.jpainsymman.2015.02.029 [doi]
AB  - CONTEXT: Up to 44% of patients with cancer-related pain require opioid rotation 
      (OR) because of inadequate analgesia or side effects. No consensus exists 
      regarding the most efficacious method for rotation to methadone. OBJECTIVES: To 
      define the available evidence regarding methods of rotation to methadone and to 
      determine if sufficient evidence exists regarding the superiority of one method. 
      METHODS: A predefined search strategy, using Medical Subject Headings (MeSH) 
      search terms and keywords combined using Boolean operators, was performed. Study 
      selection was performed according to Preferred Reporting Items for Systematic 
      Reviews and Meta-Analyses guidance. Data were extracted, quality of studies 
      assessed, and narrative synthesis undertaken. RESULTS: A total of 3214 
      potentially relevant studies were identified. Twenty-five studies were included: 
      15 retrospective and 10 prospective (n = 1229). One trial compared three-day 
      switch (3DS) and rapid conversion (RC) methods; two, 3DS; 10, RC; nine, ad 
      libitum (AL). Success rates were as follows: 3DS-93%, RC-71.7%, and AL-92.8%. The 
      single clinical trial and retrospective studies demonstrated poorer analgesia and 
      an excess of adverse events (AEs) in the RC group (five dropouts because of AEs) 
      compared with the 3DS group (no severe AEs). Time to stable analgesia was as 
      follows: RC <4.3 days and AL <6 days. CONCLUSION: Evidence identified was mainly 
      from uncontrolled observational studies, making causality difficult to establish. 
      Studies were heterogeneous in methodology and outcome measures. There was a trend 
      toward excess AEs using the RC method, in comparison to the AL and 3DS methods. 
      The methodological quality of the AL studies was low. A direct comparison of AL 
      and 3DS methods would be informative.
CI  - Copyright (c) 2015 American Academy of Hospice and Palliative Medicine. Published 
      by Elsevier Inc. All rights reserved.
FAU - McLean, Sarah
AU  - McLean S
AD  - Our Lady's Hospice and Care Services, Blackrock Hospice, Dublin, Ireland. 
      Electronic address: smclean81@yahoo.com.
FAU - Twomey, Feargal
AU  - Twomey F
AD  - Milford Hospice and University Hospital Limerick, Limerick, Ireland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20150418
PL  - United States
TA  - J Pain Symptom Manage
JT  - Journal of pain and symptom management
JID - 8605836
RN  - 0 (Analgesics, Opioid)
RN  - UC6VBE7V1Z (Methadone)
SB  - IM
MH  - Analgesics, Opioid/*therapeutic use
MH  - Humans
MH  - Methadone/*therapeutic use
MH  - Neoplasms/drug therapy/physiopathology
MH  - Pain/*drug therapy/physiopathology
MH  - Pain Management/*methods
OTO - NOTNLM
OT  - Methadone
OT  - ad libitum
OT  - cancer pain
OT  - opioid rotation
OT  - rapid conversion
OT  - review
OT  - three-day switch
EDAT- 2015/04/22 06:00
MHDA- 2016/11/12 06:00
CRDT- 2015/04/22 06:00
PHST- 2014/10/07 00:00 [received]
PHST- 2015/02/10 00:00 [revised]
PHST- 2015/02/18 00:00 [accepted]
PHST- 2015/04/22 06:00 [entrez]
PHST- 2015/04/22 06:00 [pubmed]
PHST- 2016/11/12 06:00 [medline]
AID - S0885-3924(15)00175-X [pii]
AID - 10.1016/j.jpainsymman.2015.02.029 [doi]
PST - ppublish
SO  - J Pain Symptom Manage. 2015 Aug;50(2):248-59.e1. doi: 
      10.1016/j.jpainsymman.2015.02.029. Epub 2015 Apr 18.