Pain related to the underlying disease |
Cancer progression (eg, new fracture at site of known bone metastases) |
New onset of specific etiologies of pain (eg, neuropathic pain, skin ulceration, rectal tenesmus, myalgia) that are known to be less responsive to systemic opioids or opioid monotherapy |
Psychological/spiritual pain related to the experience of an end stage illness (existential pain of impending death) |
Opioid pharmacology/technical problems |
Opioid tolerance (eg, rapid dose escalation with no analgesic effect) |
Dose-limiting opioid toxicity (eg, sedation, delirium, hyperalgesia, nausea) |
Poor oral absorption (for oral medications) or skin absorption (eg, transdermal patch adhesive failure) |
Pump, needle, or catheter problems (intravenous, subcutaneous, or spinal opioids) |
Pain unrelated to the primary disease process |
Worsening of a preexisting noncancer pain syndrome (eg, diabetic neuropathy) |
New noncancer pain syndrome (eg, dental abscess) |
Other psychological problems |
Depression, anxiety, somatization, hypochondria, factitious disorders |
Dementia and delirium both can effect a patient's report of and experience of pain |
Opioid substance use disorders or opioid diversion |
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