In 1992, the Agency for Health Care Policy and Research published clinical practice guidelines titled Acute Pain Management: Operative or Medical Procedures and Trauma.¹ These guidelines include recommendations for the approximate equianalgesic dosing for various opioid analgesics that are commonly used today in the management of acute and chronic pain. However, it has been approximately 50 years since any published study has evaluated the equianalgesic efficacy and tolerability of levorphanol. Therefore, it was our aim to evaluate the analgesia and tolerability of the suggested equianalgesic dosing guidelines for levorphanol based on the 1992 AHCPR approximate equianalgesic dosing recommendations in our cancer pain population. We retrospectively evaluated 10 consecutive patients that were converted to levorphanol from previous opioids, that were either not tolerating due to side effects or due to inadequate analgesia within the preceding 12 months. The efficacy and tolerability of levorphanol was determined by collecting patients self report of pain intensity, using the 10 point numeric rating scale, and by patients self report of tolerability at 3 and 6months post conversion. We concluded that there was no significant (p>0.05) difference in the efficacy of levorphanol at 3 and 6 months after patients were converted to levorphanol using the 1992 AHCPR recommended dosing guidelines. However, for some patients, the initial conversion dose was subtherapeutic which required a dose increase to maintain the same amount of pain relief that the patient was experiencing from the previously discontinued opioid.

References:

1.Acute Pain Management Guideline Panel. Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline. AHCPR Pub. No. 92-0032. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. Feb. 1992.