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Related Experiment Videos

Opioid responsiveness

G W Hanks1, K Forbes

  • 1University of Bristol, Department of Palliative Medicine Bristol Oncology Centre, UK.

Acta Anaesthesiologica Scandinavica
|January 1, 1997
PubMed
Summary
This summary is machine-generated.

Cancer pain management often involves opioid analgesics. Some patients experience opioid-poorly-responsive pain, defined by inadequate relief despite intolerable side effects, necessitating alternative treatments.

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Area of Science:

  • Oncology
  • Pain Management
  • Pharmacology

Background:

  • Cancer pain is typically managed with analgesics, with drug therapy being the primary treatment.
  • A significant minority of patients (around 20%) present with pain that is refractory to conventional analgesic approaches.
  • Current terminology differentiating opioid-responsive and opioid-non-responsive pain is inadequate due to its all-or-none implication.

Purpose of the Study:

  • To introduce and define the concept of "opioid-poorly-responsive pain" as a more accurate descriptor for patients with suboptimal pain relief from opioids.
  • To differentiate opioid-poorly-responsive pain from the traditional opioid-responsive/non-responsive classification.
  • To outline appropriate management strategies for patients with opioid-poorly-responsive pain.

Main Methods:

Related Experiment Videos

  • The study reviews existing literature and clinical observations regarding cancer pain management and opioid efficacy.
  • It proposes a pragmatic definition for opioid-poorly-responsive pain based on the balance between analgesia and adverse effects.
  • It identifies neuropathic pain as a common subtype of opioid-poorly-responsive pain.

Main Results:

  • Opioid-poorly-responsive pain is pragmatically defined as pain inadequately relieved by opioid analgesics at doses causing intolerable side effects, even with supportive measures.
  • Neuropathic pain is identified as the most prevalent form of opioid-poorly-responsive pain.
  • Abnormal morphine metabolism is not the cause of poor opioid response.

Conclusions:

  • Patients with opioid-poorly-responsive pain require alternative treatment strategies beyond standard opioid titration.
  • Recommended alternative treatments include utilizing alternative routes of administration (e.g., spinal), switching to different opioid agonists (e.g., phenazocine, methadone, transdermal fentanyl), and incorporating adjuvant analgesics like tricyclic antidepressants.
  • The concept of opioid-poorly-responsive pain offers a more nuanced approach to managing difficult cancer pain.