Our data indicated that by switching buprenorphine TDS to fentanyl TDS and vice versa, with a 50% reduction of the new opioid dose over Y-27632 order that given in the conversion GSK3235025 research buy tables we obtained a significant reduction of both pain and rescue medication. Moreover, side effects

decreased and no new side effects became apparent. Our results are a starting point for further studies and reiterate the importance of providing individualized treatment and taking the site of the cancer into account (the three patients who still had nausea and vomiting had gastric and gall bladder cancer). This applies not only to the therapeutic formulation but also to the side effect analysis, so that we can gain a better understanding of how much the adverse events are connected with the choice of opioid and how much they are related, or supported by, the underlying pathology of the disease. In our study we decided to change the drug and not the route of administration, because patients prefer a transdermal route as it does not interfere with their daily activities, it is easy to use,

and is non invasive. Transdermal route patients only have to remember their opioid medication every 72 hours. Reduced constipation, nausea and vomiting result in a better quality of life. These factors account for better patient compliance and lead to the feeling of greater mTOR target independency from treatment. All patients stated that they were satisfied with the therapy and this result is particularly important because, as the international literature underlines, psychological factors interfere with patients’ quality of life and disease prognosis [13, 18–20]. In contrast with our results, other studies discuss the necessity of using equianalgesic doses in opioid switching to obtain good pain control [16]. These differences

suggest that the drug, its formulation, individual response and the route of administration are all variables of fundamental importance in the therapeutic result, and that the response to opioids does not depend on the pathophysiology of the pain alone, but rather a complex phenomenon linked to individual factors. Conclusion In conclusion, we think that further studies should be performed in order to find safe and effective opioid switching methods necessary to give greater insight into the difficult balance between analgesia and toxicity. It is also important to consider individual Carbohydrate variables, such as psychological distress in cancer patients, as these are important as prognostic factors since they affect therapeutic results. References 1. Vallerand AH: The use of long-acting opioids in chronic pain management. Nurs Clin North Am 2003, 38: 435–445.CrossRefPubMed 2. Grond S, Zech D, Lehmann KA, Radbruch L, Breitenbach H, Hertel D: Transdermal fentanyl in the long term treatment of cancer pain: a prospective study of 50 patients with advanced cancer of the gastrointestinal tract or the head of neck region. Pain 1997, 69: 191–198.