Opioids in pain management
ABSTRACT Opioids are our most powerful analgesics, but politics, prejudice, and our continuing ignorance still impede optimum prescribing. Just over 100 years ago, opium poppies were still grown on the Cambridgeshire fens in the UK to provide oblivion for the working man and his family, but the brewing lobby argued on thin evidence that their potions were less dangerous. The restriction of opioid availability to protect society and the individual continues in many countries. In this review I focus on chronic and cancer pain, but many of the principles apply in acute pain. The justification for this focus is that patients with chronic pain may suffer longer and unnecessarily if we prescribe and legislate badly.
SourceAvailable from: Bert Messelink
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ABSTRACT: Opioids are widely used to treat acute and chronic pain as well as respiratory distress. There is great variability in opioid-induced side effects due to individual biological factors, patient co-morbidities and drug interactions. Normal respiratory rhythm generation is decreased primarily via inhibititory effects within the pre-Bötzinger complex. Central chemosensitivity to hypercapnia and hypoxia are blunted by opioids at the levels of the retrotrapezoid nucleus, medullary raphe nucles and nucleus tractus solitarius. Opioids also decrease central drive to both respiratory pump muscles and the upper airway dilator muscles. Opioid-induced respiratory depression can be reversed by naloxone, and recent data suggest that 5-HT4(a) agonists and ampakines are effective to reverse some of the opioid-induced respiratory depressant effects. The potentially fatal side effects of respiratory depression within the acute peri-operative setting necessitates effective monitoring of respiratory function in all patients receiving opioid therapy. Each institution needs to develop an optimal organization structure locally to define appropriate methods for avoiding medication errors, titrating opioids to target effect, and monitoring for respiratory side effects.
Article: An anthology from Naunyn-Schmiedeberg’s archives of pharmacology: O. Schaumann (1940) Über eine neue Klasse von Verbindungen mit spasmolytischer und zentral analgetischer Wirkung unter besonderer Berücksichtigung des 1-methyl-4-phenyl-piperidin-4-carbonsäure-äthylesters (Dolantin). Archiv f. experiment. Path. u. Pharmakol. 196: 109–136Archiv für Experimentelle Pathologie und Pharmakologie 01/2007; 375(2). DOI:10.1007/s00210-007-0136-z · 2.36 Impact Factor