UI - 000114

AU - Schug SA

AU - Merry AF

AU - Acland RH

TI - Treatment principles for the use of opioids in pain of nonmalignant origin. [Review]

AB - Inadequately treated acute and chronic pain remains a major cause of suffering, in spite of enormous

advances in pharmacology and technology. Opioids provide a powerful, versatile, widely available means of

managing this pain, but their use is too often restrained by ignorance and mistaken fears of addiction. The

management of postoperative pain (perhaps the most common form of acute pain) is traditionally attempted

with fixed dosages of analgesics by relatively unpredictable routes (e.g. oral, rectal and intramuscular).

Intravenous opioid infusions (an improvement) risk respiratory depression and require close monitoring and

titration. Patient-controlled analgesia (PCA), by contrast, permits the most efficacious medication (pure

opioid agonist) by the optimal route (intravenous) under direct control of the patient, and provides high

levels of satisfaction and safety. Ideally, any opioid use should be integrated with a wide spectrum of other

analgesic modalities in an anaesthesiology-based 'acute pain service'. The use of opioids for chronic pain of

nonmalignant origin remains controversial. There is a perceived conflict between patients' interests and those

of society. However, problems (such as tolerance, physical dependence, addiction and chronic toxicity),

anticipated from experience with animal experiments and pain-free abusers, seldom cause difficulties when

opioids are used appropriately to treat pain (so-called 'dual pharmacology'). With sensible guidelines, and in

the context of a multidisciplinary pain clinic, opioids may provide the only hope of relief to many sufferers of

chronic pain. [References: 88]

SO - Drugs 1991;42:228-23