Will the number of milligrams of an opioid dose ever re-achieve the truly meaningless status it deserves?
There is a notion that tolerance is an inevitable complication when patients are maintained on opioid analgesic regimens for an extended period of time. Whether this is true or not, it is important to remember that, in spite of growing regulatory scrutiny and spreading fear around these medications, defining "ceiling doses" of opioids has more to do with clinician comfort and much less to do with reality and patient requirements. This commentary posits that clinicians must return to the principles of balancing efficacy with toxicity as the dose-limiting factor once again, contextualized by outcomes in the areas of function and compliant drug-taking.
Passik
Steven D
SD
Memorial Sloan Kettering Cancer Center and Weil Medical College of Cornell University, New York, New York 10021, USA. passiks@mskcc.org
Kirsh
Kenneth L
KL
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D006801:Humans; D008297:Male; D010146:Pain / Q000145:classification / Q000188:drug therapy* / Q000523:psychology; D019966:Substance-Related Disorders / Q000209:etiology*
D000701:Analgesics, Opioid