Opioid Rotation

Opioid rotation, also called opioid switching, is the practice of changing a patient from one opioid drug to another to improve pain control or reduce unwanted side effects, introduced in the 1990s to help manage severe chronic pain. Because the dose of a single opioid cannot be raised indefinitely without causing intolerable side effects, physicians instead switch between different opioid drugs, typically every few months, to balance pain relief against tolerable adverse effects; it is used when pain relief is inadequate, when side effects are intolerable despite adequate pain control, when raising the dose stops helping, or when a different route of administration or a cost consideration is at issue. Long-term opioid use can bring on tolerance that reduces a drug's effectiveness over time, and because a poor response to one opioid does not reliably predict the response to another, more than one switch is sometimes needed before pain is well controlled.