Treatment of<unk>  tolerance and<unk>  differs but it may be difficult to differentiate these two conditions in a clinical setting where most pain assessments are done through simple scale scores. The treatment for<unk>  may be challenging because of the lack of adequate quality studies published, which is possibly due to the complexity in diagnosis of<unk>  and challenges in working with patients on chronic<unk> s. Currently there is no single best pharmacologic treatment for<unk> . One general treatment option is to gradually reduce or discontinue the dose of<unk>  to see if<unk>  is improved, although this could<unk> withdrawal symptoms that may initially increase pain.<unk>  switching, also called<unk>  rotation, is the replacement of the current<unk>  with another pharmacological agent such as morphine or methadone. It was effective in some studies, but can increase sensitivity to pain, requiring higher doses of the<unk> -sparing drug.<unk>  rotation is a safe and effective alternative to completely stopping<unk>  therapy. Methadone is also believed to show some efficacy in<unk> , presumably due to its weak NMDA antagonist activity. Ketamine, an NMDA antagonist, has been shown to prevent the extended use of<unk>  in post-operative<unk>  when it is infused in a small amount perioperatively along with the<unk>  but there are also studies that show ketamine being ineffective in modulating<unk> . The use of an NSAID, especially some COX-2 inhibitors, or acetaminophen either as monotherapy or combination therapy is also suggested as a possible treatment option.
Opioid-induced hyperalgesia
Nociplastic pain
Hypoalgesic effect of swearing
Central pain syndrome
Psychogenic pain
Neurogenic inflammation
Neuraxial blockade
Neuropathic pain