| Popis: |
This chapter presents the case of a man with failed back surgery syndrome and neuropathic pain in the leg who has a past history of psychoactive drug and alcohol abuse. He received strong opioids soon after his injury and continues to use oxycodone and hydromorphone for breakthrough pain; he never received first-line antineuropathic drug. Strong opioids are not recommended as first line for chronic neuropathic pain but, rather, only as last choice. Current or past alcohol or psychoactive drug abuse are red flags for problematic opioid use, Opioid tolerance develops very soon after opioid initiation, but opioid-induced hyperalgesia is not yet proven to be a common clinically relevant phenomenon. |
