High opioid dosage rapid detoxification of cancer patient in palliative care with the Raffaeli model

Background: Chronic opioid administration can induce adverse drug-dependent events and tolerance and/or hyperalgesia development. Opioid rotation is the treatment option in this case; however, it can expose patients to long periods of ineffectiveness and/or development of withdrawal syndrome, overdose, or adverse events. To overcome this issue, a method of rapid detoxification from opioids has been developed.Aims: To assess feasibility and efficacy of our opioid detoxification protocol in patients affected from chronic cancer pain.Settings/Patients: We studied 15 patients, with chronic cancer pain, who were afferent to Hospice of Rimini, Italy, were in therapy with high doses of opioid and needed opioid rotation or a therapeutic variation because of opioid toxicity, inefficacy, tolerance, or hyperalgesia. Each patient received a fixed dose of endovenous morphine and clonidine plus oral ketoprofen or ibuprofen, and oral lorazepam, if required, for at least 3 days, suspending the previous opioid therapy. We monitored withdrawal symptoms, pain intensity, type, and intensity of adverse events. Results: Withdrawal symptoms were experienced by four (26.6 percent) patients. The average Numerical Rating Scale for pain decreased significantly (p < 0.05) from 8.3 ± 1.57 to 3.6 ± 1.4 at the end of the detoxification and to 2.4 ± 1 at the end of the rotation or therapeutic adjustment. Average duration of the detoxification was 6.86 ± 6.4 days (range 3-22).Conclusions: The results suggested that the detoxification protocol may be effective in preventing withdrawal signs in patients needing a therapeutic change because of opioid-induced tolerance, hyperalgesia, or toxicity.