title: When the progression of disease lowers opioid requirement in cancer patients.
abstract: OBJECTIVE
  To describe 2 cases in which an abrupt progression of disease compromising pain pathways and inducing some relief of existing pain or limiting drug delivery to central nervous system.
  
  
  METHODS
  Case reports which a significant decrease of opioid requirement was reported, either systematically and spinally.
  
  
  RESULTS
  The progression of disease produced changes in pain input or limited the effects of opioids given spinally.
  
  
  CONCLUSIONS
  The data presented suggest that physicians should be aware of the possibility that opioid doses have to be reduced, where presumably specific events related to the progression of disease can change the pain syndrome or reduce the delivery of opioids when using particular routes of administration. This problem needs to be recognized and treated appropriately when it occurs.
authors.affiliation: Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, via San Lorenzo 312, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferrera
authors.forename: Loriana
authors.initials: L
authors.lastname: Di Emidio
authors.forename: Edoardo
authors.initials: E
authors.lastname: Arcuri
authors.forename: Walter
authors.initials: W
authors.lastname: Tirelli
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000556:secondary; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D010349:Patient Compliance; D010386:Pelvic Neoplasms / Q000473:pathology
chemical_list: D000701:Analgesics, Opioid