[Practical problems associated with long-term opioid therapy]

Long-term opioid therapy results in physical dependency. Therefore abrupt cessation of opioid treatment may cause acute abstinence symptoms. The doses of opioids should always be reduced gradually, even when other treatment options give good pain relief. Patients receiving long-term treatment with opioids become more sensitive to the opioid antagonist naloxone. Inappropriate use of naloxone in these patients can also result in acute abstinence symptoms. Opioid treatment is limited by toxic side effects, and the problem can be solved by changing the opioid. The author describes three cases to illustrate these problems.