Opioid "holiday" following antagonist supported detoxification during general anesthesia improves opioid agonist response in a cancer patient with opioid addiction.

TREATMENT of chronic pain in patients with a history of opioid addiction is difficult since tolerance to the opioid agonist effects may require extremely large opioid doses for pain control. Furthermore, insufficient pain control may be hard to discern from craving for more opioids. Although drug-free periods, also called “drug holiday,” can reestablish sensitivity to drugs used to treat Parkinson disease and schizophrenia this strategy has not been described for patients with chronic pain presenting with tolerance to opioids. We report an opioid addicted patient with intractable cancer pain during methadone substitution therapy in whom antagonist supported opioid detoxification and a drug holiday reestablished sensitivity to opioids and improved cancer pain.