Oldenmenger, W.H., Lieverse, P.J., Janssen, P.J., Taal, W., van der Rijt, C.C., & Jager, A. (2012). Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids. Supportive Care in Cancer, 20, 1639–1647.
To describe the analgesic efficacy and side effects of parenteral hydromorphone among patients with severe cancer-related pain
Medical records were reviewed and data were collected retrospectively for patients admitted to a palliative care unit for pain management because of uncontrolled pain or severe side effects from their current pain regimens. Patients were started on parenteral hydromorphone. After starting the intervention, pain intensity and side effects were recorded twice daily. All patients had previously received opioids.
Adequate pain control was reported for 83% of patients, and among those who had improvement, the decline in mean pain score was significant (p < .001), ranging from a 2.7–3.1-point reduction. Seventeen percent had no response. Survival analysis showed continued effect of hydromorphone for 150 days for those who continued on the study (35 patients).
Switching to parenteral hydromorphone was effective for pain control in some patients who had either uncontrolled pain or severe side effects with previous pain medication regimens.
Findings suggest that opioid rotation to parenteral hydromorphone was effective for some patients who had either uncontrolled pain or unacceptable opioid side effects. This study provides rather weak evidence because of numerous study limitations, but, for those patients at the end of life with intractable pain or significant adverse effects on current pain regimens, alternative approaches that may be effective are important to consider. Parenteral hydromorphone may be an appropriate alternative for these patients.