الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Opioid rotation involves changing from one opioid to another or one route of administration to another, using correct equianalgesic conversion techniques to achieve better analgesia and or fewer side effects the strategy appears to work because of significant interindividual variations in response to both analgesic activity and toxicity although there are many retrospective studies. few prospective controlled trials of opioid rotation have been published the practical and theortical advantages of opioid rotation include improved analgesia, reduced side effects, cost reduction, and improved compliance. Disadvantages include problems related to inaccurate conversion tables, limited availability of certain opioid formulations, drug interactions, and the possibility of increased expense. Weighting the advantages and disadvantages is essential prior to making a decision about opioid rotation selection. Opioid rotation has been shown to be useful in opening the therapeutic window and establishing a more advantageous analgesia. Opioid responiveness to difficult pain syndromes should not be based on the results obtained by single drug more studies are necessary to obtain more knowledge of the opioid response in patients with difficult pain syndromes. opioid neurotoxicity, possibly associated factors and drugs that limit excitatory symptoms are other research areas for future exploration. In this study, we conclude that patients switched to oxycodone improved score of pain. Due to increase bioavailability of oxycodone. Patients switched to transdermal fentanyl improved nausea, vomiting, constipation and kidney function (improved serum creatinine and serum uric acid).