Opioid rotation

Opioid rotation is usually reserved to patients with cancer pain, or in patients receiving palliative care. It takes advantage of incomplete cross-tolerance between opioids; a long-term opioid is changed to another opioid to reduce the required dose of opioid, while providing similar analgesia or reducing adverse effects. Opioid rotation rarely improves analgesic efficacy (ie if an opioid has been ineffective changing to another opioid will not improve treatment efficacy) and is associated with overdose—seek specialist advice.