The purpose of this retrospective study was to determine the therapeutic value 
of opioid rotation in a large pediatric oncology center. The details for opioid 
prescriptions, over the course of a year, were obtained from the medical records 
of children with cancer who had a rotation of opioid during their admission. 
Twenty-two children or 14% of children on opioid therapy underwent 30 opioid 
rotations. Mucositis was the cause of pain in 19 (70%) children, bone pain in 3 
(11%) children, and postoperative, visceral, or neuropathic pain in the 
remainder. The opioid was rotated either for excessive side effects with 
adequate analgesia (70%), excessive side effects with inadequate analgesia 
(16.7%), or tolerance (6.7%). Five (23%) children required two rotations, 3 
during the same admission. The favored rotations were morphine to fentanyl in 20 
(67%) children and fentanyl to hydromorphone in 6 (20%). Adverse opioid effects 
were resolved in 90% of cases, all failures occurred when morphine was rotated 
to fentanyl. There was no significant loss of pain control or increase in mean 
morphine equivalent dose requirements. Opioid rotation had a positive impact on 
managing dose-limiting side effects of, or tolerance to, opioid therapy during 
cancer pain treatment in children. This was accomplished without loss of pain 
control or having to significantly increase the dose of opioid therapy.