Opioid Analgesics

Abstract

Chronic pain is an international health issue of immense importance that is influenced by both physical and psychological factors. Opioids are useful in treating chronic pain but have accompanying complications. It is important for clinicians to understand the basics of opioid pharmacology, the benefits and adverse effects of opioids, and related problematic issues of tolerance, dependence, and opioid-induced hyperalgesia. In this article, the role of psychiatric comorbidity and the use of validated assessment tools to identify individuals who are at the greatest risk for opioid misuse are discussed. Additionally, interventional treatment strategies for patients with chronic pain who are at risk for opioid misuse are presented. Specific behavioral interventions designed to improve adherence with prescription opioids among persons treated for chronic pain, such as frequent monitoring, periodic urine screens, opioid therapy agreements, opioid checklists, and motivational counseling, are also reviewed. Use of state-sponsored prescription drug monitoring programs is also encouraged. Areas requiring additional investigation are identified, and the future role of abuse-deterrent opioids and innovative technology in addressing issues of opioid therapy and pain are presented.

Manejo del dolor: Trastorno por uso de opiáceos de prescripción médica y su relación con la práctica clínica

“…Entre los receptores opioides, por su parte, existen diversos subtipos, destacando los receptores Mu (μ), Kappa (κ) y Delta (δ), con efectos diversos en relación a la modulación de acciones en los distintos sistemas fisiológicos 8 . Los distintos opiáceos tienen diversa afinidad por uno o más receptores, pudiendo actuar de manera agonista, antagonista, o de acción mixta, como agonista parcial o como agonista-antagonista si actúan en más de un receptor.…”

Combining pain therapy with lifestyle: the role of personalized nutrition and nutritional supplements according to the SIMPAR Feed Your Destiny approach

“…Despite their drawbacks, opioids are still considered by many as the most effective analgesic for chronic pain 20,21. One of the main concerns regarding their use is opioid-induced constipation (OIC), due to their binding to receptors in the gastrointestinal (GI) tract.…”

The Chronic Pain Patient in the Emergency Department

“…Allodynia refers to pain that some patients experience from stimuli generally not thought to be painful (certain fabrics against the skin for example), whereas hyperalgesia refers to disproportionate pain to a noxious stimulus. A specific phenomenon, opioidinduced hyperalgesia, is the result of a paradoxical increase in pain due to hyperalgesia or allodynia from excessive opioid exposure [11,12]. Pain from nerve fiber injury causing spontaneous firing produces neuropathic pain, sometimes referred to as causalgia.…”

“…Screening for these risk factors may help with efforts in managing overprescribing to this vulnerable population. Risk factors include age \65, depression or anxiety, psychotropic medication use, and pain impairment as defined by Brief Pain Inventory, greater than 180 mg morphine equivalent per day, family or personal history of substance abuse, history of criminal activity or legal problems, regular contact with high-risk people or highrisk environments, risk taking behavior, heavy tobacco use, and prior drug and/or alcohol rehabilitation [12,21]. Another concern is the concurrent usage of benzodiazepines.…”