G. W. Terman, M.D., Ph.D.
Never in the history of mankind has so much opiate tolerance existed in the general population. Well meaning attempts to minimize chronic pain in the estimated 1 in 5 adults who suffer from such maladies has resulted in many individuals being treated with opiate analgesics for long periods of time. Sadly, opiates become less effective over time - demonstrating analgesic tolerance. Such opiate tolerance requires an ever increasing escalation of dose or a resignation to the fact that more and more pain must be "lived with" and is a fact of life for literally millions in the United States alone. An acute example of the problems caused by opiate tolerance occurs post-operatively when individuals on chronic opiates become very challenging pain management problems. At the University of Washington, we have previously reported (Rapp et al, Pain, 2005) that patients on at least 6 weeks of opiate treatment received 3 times more opiates for their post-operative pain and still had higher pain scores and significantly more sedative side effects than opiate naive patients receiving matched surgeries. Regardless of whether the surgery is in the same area as the chronic pain or not, opiate tolerance does not discriminate and slows functional recovery after surgery due to increased pain AND side effects - sometimes negating surgical benefits. Patients on chronic opiate therapy need another approach to help improve their post-operative pain control.