Opioids Resistance in Chronic Pain Management

Abstract

Chronic pain management represents a serious healthcare problem worldwide. Chronic pain affects approximately 20% of the adult European population and is more frequent in women and older people. Unfortunately, its management in the community remains generally unsatisfactory and rarely under the control of currently available analgesics. Opioids have been used as analgesics for a long history and are among the most used drugs; however, while there is no debate over their short term use for pain management, limited evidence supports their efficacy of long-term treatment for chronic non-cancer pain. Therapy with opioids is hampered by inter-individual variability and serious side effects and some opioids often result ineffective in the treatment of chronic pain and their use is controversial. Accordingly, for a better control of chronic pain a deeper knowledge of the molecular mechanisms underlying resistance to opiates is mandatory.

Therapeutic experience with tramadol for opioid dependence in a patient with chronic low back pain: a case report

“…Inadequate pain management led to drug-seeking behaviors that resemble those seen with opioid addiction. This phenomenon is referred to as pseudoaddiction [9,10]. In clinical settings, pseudoaddiction can be distinguished from opioid dependence in that the behaviors disappear after appropriate pain treatment.…”

“…In clinical settings, pseudoaddiction can be distinguished from opioid dependence in that the behaviors disappear after appropriate pain treatment. On the other hand, opioid tolerance develops with repeated opioid exposure, resulting in a decrease in the analgesic effect [10,11]. The development of opioid tolerance has been reported to lead to an increase in opioid consumption and the risk of addiction.…”

Chronic opioid use and clinical outcomes in lung transplant recipients: A single‐center cohort study

“…However, the complexity of pain in transplant patients may influence physicians to select opioids as a first‐line therapy. The analgesic effect of opioid therapy has been extensively documented . Nevertheless, studies have shown that the perceived analgesic benefits of opioids are often overstated, with one study suggesting that 71% of opioid users reported less than a 30% decrease in general chronic pain …”

“…The analgesic effect of opioid therapy has been extensively documented. 19,20 Nevertheless, studies have shown that the perceived analgesic benefits of opioids are often overstated, with one study suggesting that 71% of opioid users reported less than a 30% decrease in general chronic pain. 21 Adverse effects of chronic opioid use are increasingly described in the literature, yet no studies have reported adverse outcomes associated with these medications in either adult or pediatric LTx recipients, notwithstanding widespread opioid use in this population.…”

The need for better access to pain treatment: learning from drug consumption trends in the USA

“…Opioids are fundamental to provide relief from cancer pain; however, evidence is lacking for their effectiveness when used for the treatment of chronic non-cancer pain, and these drugs are associated with a number of serious side effects (see Morrone et al, 2017). During the opioid epidemic, from 1999 to 2014, the rate of opioid prescription increased fourfold (Prevention CfDCa, MMWR 2011) and it has been calculated that from 2007 to 2012 one in five patients with non-cancer pain or with a pain-related diagnosis received an opioid prescription for the management of acute and chronic pain (Daubresse et al, 2013).…”