If a pain patient reports that an opioid does not provide adequate pain control, then it is important to identify possible explanations.

Differential diagnosis of failure in pain control with an opioid:

(1) the dose of the opioid is too low

(2) the patient has developed tolerance to the opioid

(3) an opioid is not appropriate for the patient's type of pain

(4) there is a drug-drug interaction that is interfering with opioid action (increased excretion, etc)

(5) the underlying cause of the pain has progressed

(6) the patient has developed a new pain condition

(7) the patient is noncompliant

(8) the opioid has deteriorated

(9) someone has substituted another drug for the opioid

(10) opioid-related hyperalgesia

(11) malingering in order to get more opioid

(12) poor coping or depression

(13) pharmacogenetic issue associated with associated with increased metabolism

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