For patients with nonmalignant pain, “drug holidays” may be used to address drug tolerance. How often and at what point should they be implemented?
A patient who has had progressively increasing dose requirements and no longer receives sufficient symptom relief may benefit from a “drug holiday.” A careful history taking may reveal that the pain is much worse with certain, predictable patterns or at certain times of the day. In this case, delivering more medicine at these times (complex continuous programming) may allow better control without increasing the overall daily dose. The role of the drug holiday approach in the management of patients receiving intrathecal analgesic infusions has not been established. The specific timing of drug holidays varies with the individual patient and the managing physician but can be considered: When the patient is receiving the maximum dose of medication that s/he and the physician are comfortable delivering intrathecally, or If further dose increases are limited by the delivery rate of the infusion system. In general, holidays of several days to several weeks have been described, but the time ne
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