Opioid poorly-responsive cancer pain. Part 3. Clinical strategies lo improve opioid responsiveness

Some pain syndromes may be difficult to treat due to a poor response to opi oids. This situation demands a range of alternative measures, including the use of adjuvant drugs with independent effects, such as antidepressants, s odium channel-blocking agents, steroids and anti-inflammatory drugs (NSAIDs ); drugs that reduce opioid side effects; and drugs that enhance analgesia produced by opioids, such as N-methyl-D-aspartate (NMDA) antagonists, calci um channel antagonists, and clonidine. Other approaches, including opioid t rials, neural blockade when necessary and psychological interventions, also may be useful. (C) U.S. Cancer Pain Relief Committee, 2001.