When the progression of disease lowers opioid requirement in cancer patients.
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.
Mercadante
Sebastiano
S
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, via San Lorenzo 312, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
Ferrera
Patrizia
P
Di Emidio
Loriana
L
Arcuri
Edoardo
E
Tirelli
Walter
W
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
D000701:Analgesics, Opioid