A Pilot Study of Switching From One Pain Medication to Another (Opioid Rotation)

A Pilot Study of Rapid Opioid Rotation and Titration of Oxymorphone

The purpose of this study is to see if changing from one pain medication like morphine or oxycodone to another pain medication, oxymorphone (OPANA®), will be helpful to patients. This study will examine if the switching from one pain medication to another can be done over a 24 hour period. Oxymorphone, the drug being studied, is an FDA approved drug for treatment of severe pain.

Inclusion Criteria:

• Age of 18 to no upper limit
• Chronic pain of nociceptive, neuropathic, or mixed origin
• Patients with chronic non cancer pain
• Ongoing chronic opioid treatment with either oral morphine or oxycodone (long term - more than 3 months of at least a total daily opioid dose of 60 mg morphine or of 30 mg oxycodone)
• Pain of moderate intensity (>4, on the numerical scale 0-10) despite ongoing opioid therapy>
• Non-pregnant, non-lactating women
• Sufficient language skills to communicate with research staff

Exclusion Criteria:Non-ambulatory patients

• Clinically significant respiratory, renal, hepatic, or cardiac disease.
• Documented diagnosis of sleep apnea (the study physician may exclude patients who present with clinical features and complaints suggestive of a diagnosis of probable sleep apnea)
• History of illicit drug or alcohol dependence or abuse, abnormal drug taking / seeking behaviors
• Severe depression (> 26 on the BDI)
• Patients who exhibit a score on the Mini Mental Status Exam (MMSE) of 26 or less. (The range of scores for mild dementia is 21-26 on the MMSE).
• Workman compensation, current or pending medical-legal litigation
• Hypersensitivity to study medication (oxymorphone)