• Jane E Loitman.
• Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA. je17089@bjc.org
• J Palliat Med. 2006 Dec 1; 9 (6): 1250-3.

BackgroundPain, not responsive to opioid analgesics, remains a problem for patients with chronic and cancer pain as well as their families, and clinicians. Opioid antagonists have various uses in pain and palliative care. Their use in the reversal of tolerance and hyperalgesia remains at the basic science level and has limited clinical exposure.ObjectiveTo improve symptom control and quality of life in patients with pain not responsive to opioid analgesics.DesignPresent three cases in which patients have undergone administration of opioid antagonists for the purpose of analgesia.MethodsPatients on opioids analgesics received parenteral opioid antagonist, naloxone. Complete withdrawal under a sedative or conscious sedation was allowed and then the opioid at smaller doses was restarted and analgesia was observed.ResultsAll patients had improved analgesia on a significantly lower dose of opioid analgesics.ConclusionsOnly three patients who have received this procedure were presented yet all have responded positively to this procedure. Further research is needed to elucidate the mechanism and clinical relevance in the acute use of opioid antagonists.

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