The NHG has given these drugs an equal place in treatment policy given the extensive experience that has now been gained with both drugs. The 2021 guideline only expressed preference for morphine.
It is recommended to preferably administer these opioids orally and to opt for a delayed-release preparation that the patient can take at fixed times. Rectal administration of morphine is not recommended, because this can lead to variable and incomplete absorption into the blood. If there are problems with oral administration, the doctor may consider a patch containing fentanyl or buprenorphine. Most experience has been gained with fentanyl and the advantage of a buprenorphine patch is that the starting dose can be lower. Parenteral administration of morphine may be considered.
Opioid rotation
If pain relief remains necessary and habituation occurs, it is advisable to gradually increase the dosage to maintain the desired effect. If the response is insufficient, opioid rotation should be considered. The equivalent dose of the alternative should be given. For opioid rotation due to side effects, it is best to start with 75% of the equivalent 24-hour dose.
Once again a warning is issued about the use of opioids in people with chronic pain. The NHG indicates that it is very cautious about the use of these substances. This is because the effect on pain due to sensitization is generally limited and there is a risk of serious side effects.
2023-09-12 05:02:26
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