Opioid antagonists may be useful in control of intractable pain in advanced disease. A case series

Zbigniew Zylicz; Robert Twycross; Małgorzata Krajnik

Vol 9, No 4 (2010)

Case reports

Published online: 2011-02-02

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Opioid antagonists may be useful in control of intractable pain in advanced disease. A case series

Zbigniew Zylicz, Robert Twycross, Małgorzata Krajnik

Advances in Palliative Medicine 2010;9(4):123-128.

Vol 9, No 4 (2010)

Case reports

Published online: 2011-02-02

Abstract

Opioid antagonists naloxone and naltrexone administered in ultra low doses are able to control pain which originates from opioid induced pain facilitation or hyperalgesia. In this article we describe a series of patients with intractable pain treated compassionately with ultra low doses of naloxone or naltrexone. Most of the patients suffered of advanced cancer disease and were treated with high doses of opioids. However, one patient suffered of non-malignant pain and did not tolerate exogenous opioids at all. She responded to ultralow doses of naloxone and naltrexone alone suggesting that endogenous opioids may also play a role in pathological pain conditions. Basing on this case series we discuss current literature, trying to make sense out of plethora of negative and positive findings.

Adv. Pall. Med. 2010; 9, 4: 123–128

Abstract

Opioid antagonists naloxone and naltrexone administered in ultra low doses are able to control pain which originates from opioid induced pain facilitation or hyperalgesia. In this article we describe a series of patients with intractable pain treated compassionately with ultra low doses of naloxone or naltrexone. Most of the patients suffered of advanced cancer disease and were treated with high doses of opioids. However, one patient suffered of non-malignant pain and did not tolerate exogenous opioids at all. She responded to ultralow doses of naloxone and naltrexone alone suggesting that endogenous opioids may also play a role in pathological pain conditions. Basing on this case series we discuss current literature, trying to make sense out of plethora of negative and positive findings.
Adv. Pall. Med. 2010; 9, 4: 123–128

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Keywords

opioid induced hyperalgesia; naloxone; opioid antagonists; pain; cancer

About this article

Title

Opioid antagonists may be useful in control of intractable pain in advanced disease. A case series

Journal

Advances in Palliative Medicine

Issue

Vol 9, No 4 (2010)

Pages

123-128

Published online

2011-02-02

Page views

475

Article views/downloads

1003

Bibliographic record

Advances in Palliative Medicine 2010;9(4):123-128.

Keywords

opioid induced hyperalgesia
naloxone
opioid antagonists
pain
cancer

Authors

Zbigniew Zylicz
Robert Twycross
Małgorzata Krajnik