Objective: To describe 2 cases in which an abrupt progression of disease compromising pain pathways and inducing some relief of existing pain or limiting drug delivery to central nervous system.
Methods: Case reports which a significant decrease of opioid requirement was reported, either systematically and spinally.
Results: The progression of disease produced changes in pain input or limited the effects of opioids given spinally.
Discussion: The data presented suggest that physicians should be aware of the possibility that opioid doses have to be reduced, where presumably specific events related to the progression of disease can change the pain syndrome or reduce the delivery of opioids when using particular routes of administration. This problem needs to be recognized and treated appropriately when it occurs.
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