Recommendations Given on Opioid Conversions to Improve Pain Control

Background: Although most patients respond to the initial opioid, opioid rotation is used to reduce side effects and improve pain control. Opioid conversion ratios provide a dose between withdrawal and toxicity, but are not precise enough to be labeled equianalgesic, so further dose refinements will be necessary. Objective: To answer the following questions: (1) What assessments are important before conversion? (2) How are opioid conversions done? (3) What assessments are important after conversion? Methods: Data were collected from 370 palliative care professionals in 53 countries. A total of 140 randomized controlled trials and 68 nonrandomized trials were selected for the systematic review. Recommendations: (1) Assess total pain, including emotional, social, isolation, and financial distress, which may affect the perception of pain. Consider the source of pain, past medications, and other pain management options. Some pain syndromes are more and some are less responsive to opioids more...