[Opioid treatment of pain in angina pectoris]

We report four cases in which painful angina pectoris was treated with opioids on an as required basis. When the opioid treatment covering the 24-hour period had been established, the number of angina pectoris attacks was reduced by 75-90%. The remaining attacks became less intense. Long-term opioid therapy is complicated by physical dependency, as defined by withdrawal symptoms when the opioid is reduced or eliminated. Most patients do not recognise their withdrawal symptoms, and often the symptoms are mistaken simply as pain. Breakthrough withdrawal symptoms may occur as a consequence of opioid treatment administered on an as required basis.