UI - 000207

AU - Galer BS

AU - Coyle N

AU - Pasternak GW

AU - Portenoy RK

TI - Individual variability in the response to different opioids: report of five cases

AB - AB - Although it is widely appreciated that patients can demonstrate highly variable responses to

different opioid drugs, there have been few detailed descriptions of this phenomenon. To illustrate this

variability, we present 5 patients, 4 with cancer pain and 1 with non- malignant pain, who underwent dose

titration with more than 1 opioid and developed markedly different responses to each. In every case, dose

escalation led to successful treatment with 1 opioid and to intolerable side effects without adequate relief

with others. The existence of this individual variability in the response to different opioids has important

implications for both clinical practice and current understanding of opioid pharmacology in man. It

contradicts the view that any opioid is inherently more efficacious than any other, suggests that patients who

fail to obtain adequate pain relief at maximally tolerated doses of 1 opioid may benefit from an alternative

drug, and underscores the potential importance of genetic factors as a determinant of opioid response. AD -

Department of Neurology AD - Memorial Sloan-Kettering Cancer Center AD - New York AD - NY 10021

UI - 92278827

SO - Pain 1992;49:87-9