Journal of opioid management
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Case Reports
Perioperative dilemma: challenges of the management of a patient on mega doses of morphine and methadone.
High doses of opioids are often needed in the management of cancer-related pain. A discussion of a patient's perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented. ⋯ Use of high dose opioids is associated with numerous challenges, including tolerance. The successful management of this patient was multimodal and included the use of potent analgesics, N-methyl-D-aspartatereceptor antagonists, and the α-2 agonist clonidine.
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This survey highlights the perspective of patients with chronic pain when confronted with the possibility of abrupt opioid discontinuation. ⋯ These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care.