Opioid rotation in the treatment of joint pain. A review of 67 cases

Joint Bone Spine. 2002 Oct;69(5):491-4. doi: 10.1016/s1297-319x(02)00435-9.


Objective: To determine that opioid rotation can be useful for establishing a more advantageous analgesia/toxicity relationship in rheumatologic pain.

Methods: Among patients treated with opioids for rheumatologic non-malignant pain, 67 patients with opioid rotation were enrolled retrospectively. In all cases, the other analgesics had failed. The opioids used were: oral morphine, oral hydromorphone, oral buprenorphine and transdermal fentanyl. The reasons for rotation were noted and the improvement of pain was assessed by comparing baseline and post-treatment visual analog scales (VAS in mm).

Results: The 67 patients suffered from low back pain with sciatica in 27 cases, inflammatory arthritis in 14 cases, brachial neuralgia in six cases, osteoarthritis in eight cases and miscellaneous in 12 cases. The opioid rotations were the substitution of morphine by transdermal fentanyl, by oral hydromorphone in most of the cases. The principal reason for opioid rotation was failure of the first treatment. The mean of VAS improvement was 30 mm (P < 0.001).

Conclusion: In rheumatologic non-malignant pain, the opioid rotation might allow the physician to bypass side effects or failure to alleviate pain in most cases.

MeSH terms

  • Administration, Cutaneous
  • Administration, Oral
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use
  • Drug Administration Schedule
  • Fentanyl / administration & dosage
  • Fentanyl / therapeutic use
  • Humans
  • Hydromorphone / administration & dosage
  • Hydromorphone / therapeutic use
  • Joints* / physiopathology
  • Morphine / administration & dosage
  • Morphine / therapeutic use
  • Pain / etiology
  • Pain / physiopathology
  • Pain / prevention & control*
  • Pain Measurement
  • Retrospective Studies
  • Rheumatic Diseases / complications
  • Rheumatic Diseases / drug therapy*
  • Rheumatology / methods*
  • Treatment Outcome


  • Analgesics, Opioid
  • Buprenorphine
  • Morphine
  • Hydromorphone
  • Fentanyl