Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options

Abstract

Nausea and vomiting side effects limit the analgesic efficiency of current opioid therapies. There is a clear need for the development of improved opioid-based analgesics that mitigate these intolerable effects.

Pharmacological treatment of chronic pain – the need for CHANGE

“…The quality of life of patients is frequently impaired by inadequate pain relief or unacceptable side-effects, or both. As a result, many patients discontinue their opioid analgesic treatment, principally because of gastrointestinal and CNS side effects 43,44 . Systematic reviews have shown that 20%-30% of patients who received opioids for chronic noncancer pain in controlled clinical trials discontinued their treatment, principally as a result of adverse events 45,46 ( Figure 5).…”

Tapentadol Prolonged Release Versus Strong Opioids for Severe, Chronic Low Back Pain: Results of an Open-Label, Phase 3b Study

“…Gastrointestinal side effects, including nausea, constipation, and vomiting, are among the most commonly reported opioid-related side effects [4], and patients have reported that these are the most bothersome side effects associated with opioid treatment [6,7]. Patients often miss or decrease their dose of opioid analgesic or discontinue opioid treatment to avoid nausea, vomiting, and constipation [7,8], and physicians often discontinue opioid therapy because of these side effects [9]. In a survey [8] of 322 patients taking daily oral opioids and laxatives, 33% of patients had skipped, decreased, or stopped their opioid analgesic in order to obtain relief from opioid-induced constipation.…”

A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery

“…Although (NSAID) may be beneficial analgesics, many surgeons do not prefer them in thyroidectomy patients to limit the risk of postoperative bleeding [4] [5]. On the other hand, opioids have been associated with some adverse events as respiratory depression and frequent postoperative nausea and vomiting [6] [7]. So it was necessary to find safe analgesic techniques for these patients by using either different adjuvant therapies or multimodal analgesia by combining different drugs and techniques with different modes of action to improve the quality of postoperative analgesia and to decrease the doses of systemic opioids and their related side effects [8] [9].…”