Understanding opioid tolerance in cancer pain

Abstract

Purpose/objectives: To review opioid tolerance in chronic cancer pain, define the phenomenon and its scope, review physiologic mechanisms, and discuss clinical strategies to identify and manage this complex issue.

Data sources: Review articles, case studies, original research, and published guidelines.

Data synthesis: Novel therapies to prevent/reverse tolerance are being investigated with a possible future role for N-methyl-d-aspartate antagonists.

Conclusions: Greater nursing research is needed to identify patient risk factors for tolerance development and clinical measurement of the phenomenon. Understanding cellular mechanisms for tolerance may contribute to better management.

Implications for nursing practice: Nursing knowledge of tolerance is important to provide the basis for accurate patient assessment, education, and pain management.