Vicious Circle – balancing efficacy and tolerability

The pharmacological treatment of severe chronic pain is in many cases often inefficient. Patients are often not adequately treated and if they have access to potent substances the balance between sufficient pain relief and acceptable tolerability as well as tailoring the treatment to the pain is difficult to maintain.


But what makes treatment so complicated?

Insufficient analgesic efficacy which is accompanied by an acceptable tolerability leads to dose increases in order to achieve satisfactory pain relief. Due to dose-dependent efficacy of classical opioids, the dose increase may result in effective analgesia. However, at the same time it increases the dose-dependent risk of side-effects. When tolerability becomes unacceptable and/or side-effect attenuating medications (e.g., antiemetics against opioid-induced nausea and vomiting) do not show their desired effect, physicians or even patients themselves reduce the analgesic dose. Indeed, tolerability is improved – but inadequate analgesia is the unintentional consequence.


Learn more about the Vicious Circle

The result of the Vicious Circle can either be side effects, lack of efficacy or analgesic tolerance which may all lead to treatment discontinuations and low compliance of patients.

The Vicious Circle starts rotating


Varrassi G et al. Pharmacological treatment of chronic pain - the need for CHANGE. Cur Med Res Opin, 2010, 26(5): 1231-1245.