Opiate-Resistant Pain: A Therapeutic Dilemma

  • N. MacDonald
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 121)

Abstract

Pain is opiate-resistant when inadequate analgesia is achieved at levels of opiate therapy which cause intolerable side effects. Opiate resistance is associated with a number of cancer pain syndromes and patient profiles characterized by psychosocial distress, metabolic abnormalities, idiosyncratic reactions to opiate therapy, or the rapid development of tolerance. In the first group nerve damage pain, activity-related (incident) pain, muscle spasm pain, many forms of headache and tenesmoid pain are characteristically difficult to treat with opiates. When cancer occurs against a background of profound psychosocial and emotional distress, opiate and indeed virtually all pharmacological therapies are of little avail—pain only improves with resolution of the emotional-spiritual crisis. Aside from psychological disturbances, factors of inheritance, background metabolic abnormalities, increasing age and/or diminished cognitive status may cause certain cancer patients to be subject to increased side effects of opiates. Less clearly defined is the problem of some cancer patients who develop rapid tolerance and require spiralling doses of opiates to maintain pain control.

Keywords

Placebo Corticosteroid Morphine Neuropathy Oncol 

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Copyright information

© Springer-Verlag Berlin · Heidelberg 1991

Authors and Affiliations

  • N. MacDonald
    • 1
  1. 1.Palliative MedicineUniversity of AlbertaEdmontonCanada

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