The first, tolerance, requires increasing the dose to maintain analgesia. Tolerance is a receptor phenomenon. In fact, some data suggest that maintenance on opioids for a long period of time leads to an increased sensitivity to pain, thus requiring more opioids. This happens as part of the physiology of using these drugs. This is not addiction.
Physical dependence occurs during opioid therapy as a normal response to therapy.
No order for opioids is intiated. Six to eight hours later the patient begins to experience sweat, lacrimation, and abdominal pain. Addiction is a psychological problem manifested by drug-seeking behavior. The symptoms of sudden withdrawal are similar to those seen with physical dependence but the clinician should not confuse the two. When designing a pain protocol for the elderly using opioids, Dr. Forman advised being aware of the increased sensitivity to the drugs and their unwanted effects.