Clinical Approaches to Special Issues Related to Opioid Therapy

Objectives To summarize the unique characteristics of methadone and the putative mechanisms of rapid-onset opioid formulations for breakthrough pain; to outline the principles underlying opioid rotation; and to describe elements of risk assessment in opioid therapy. Data Sources Published research articles and clinical experience. Conclusion Risk management for opioid therapy should involve multiple approaches, tools, and regular patient interactions; urine toxicology can be used to confirm suspicion of aberrant behavior. Yet, some aberrant drug-related behaviors can reflect opioid efficacy failure or a deterioration of the underlying condition. Opioid rotation can be an effective tool to manage cases where opioids have not effectively controlled pain or were associated with intolerable side effects. However, dose conversion requires careful calculation and continuing follow-up care. Treatment of both baseline pain and breakthrough pain is essential as both can erode an individual's quality of life. Implications for Nursing Practice Oncology nurses can better address challenging clinical scenarios associated with opioid therapy.