| Methods |
"Retrospective chart review" containing mostly elements of a case series. Patients initially assigned to one of four long‐acting opioids: sustained‐release morphine or oxycodone; methadone; or transdermal fentanyl. Patients were switched to (an) alternative opioid(s) if first (or subsequent) opioids were ineffective or intolerable. |
| Participants |
86 patients (50 women and 36 men) with diverse chronic non‐cancer pain diagnoses. |
| Interventions |
Initial opioid: methadone (starting dose: 5 mg to 20 mg four times a day, titrating up in 5 mg increments), sustained‐release morphine or oxycodone, or transdermal fentanyl. Patients could switch to any one of the other three opioids or immediate‐release oxycodone, levorphanol or hydrocodone. Mean methadone dose from initial opioid = 35.4 mg. |
| Outcomes |
For each rotation, number of patients: with at least 50% pain relief; switching opioids due to intolerable side effects (> 30 on a 0 to 100 scale); switching due to lack of effectiveness (less than 50% pain relief); with any side effect. |
| Notes |
Non‐RCT. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
High risk |
Not randomised see Table 1 and Appendix 6 for quality assessment and risk of bias |
| Allocation concealment (selection bias) |
High risk |
Not randomised |
| Blinding (performance bias and detection bias)
All outcomes |
High risk |
Not possible due to study design |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
Not clear |
| Selective reporting (reporting bias) |
Unclear risk |
Not clear |
