Palliative care 2017

Opioid resistance: ‘wind up’

• Allodynia : altered sensitivity of central neurones with relatively minor pain being perceived as severe pain

• NMDA (N-methyl-D-aspartate receptors mediate allodynia

• NMDA receptor antagonists eg methadone or ketamine may be of value in resetting opoioid tolerance: hence work best with morphine