Tolerance to opioid therapy commonly occurs but this usually doesn't equate to addiction. The patient simply may need to get a higher dose to get the pain relief being sought. Addiction includes loss of control, compulsive use, continued use despite harm, and preoccupation with seeking the drug. Assess the patient regularly for degree of analgesia, emergence of side effects, functional status, and aberrant drug related behaviors. Use the longer acting opioids over the short acting.
Hydroxyzine can be effective.