Narcotic analgesics for chronic pain management

Eriator, Ike

doi:10.1007/s11916-998-0019-0

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…Similarly, patients with worsening cancer-related pain who require dose escalations typically do not exhibit respiratory and CNS depressant effects when additional opioids are administered (75,(77)(78)(79). It has been suggested that acute pain serves as a natural antagonist to opioid-associated respiratory and CNS depression (15,43). This purported effect is supported by the observation that a patient with chronic pain who was treated with opioids developed signs of respiratory depression after a successful nerve block procedure (80).…”

Section: Misconception 3: the Additive Effects Of Opioid Analgesics Amentioning

confidence: 99%

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Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

2006

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More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.

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Section: Misconception 3: the Additive Effects Of Opioid Analgesics Amentioning

confidence: 99%

“…The clinical approach is complicated by the confusing and often misunderstood terminology used in pain management and addiction medicine (40)(41)(42)(43). As detailed in Table 1, physical dependence and tolerance are typical and predictable physiologic consequences of opioid exposure.…”

Section: Pain and Opioid Dependencementioning

confidence: 99%

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

2006

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“…However, even addictive behaviors such as uncontrolled dose escalation, "losing" prescriptions, and obtaining opioids from more than one physician, have been considered "pseudoaddiction" [60,61] due to undertreatment of pain (with opioids). Opioids are believed to be efficacious for persistent, severe pain just as they are for acute pain.…”

Section: The Controversy Of Efficacy Versus Addictionmentioning

confidence: 99%

Pain management in the opioid-dependent patient

Streltzer

2001

Curr Psychiatry Rep

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The opioid-dependent patient presents great challenges for pain management. These challenges are not limited to potential addictive behaviors. In contrast to the profound pain relieving effects of acute opioid intake, chronic opioid intake can promote a counterintuitive state of enhanced pain sensitivity. Multiple biologic mechanisms inducing opioid tolerance and hyperalgesia have recently been elucidated. The potential hyperalgesic state accompanying opioid dependence complicates pain management somewhat for acute pain and cancer pain, but it especially does so for chronic pain. Guidelines for treatment of opioid dependence in the pain patient are proposed. Treatment oriented toward the long term requires limit setting and psychologic support that go beyond simple medication management.

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“…Overall, this route of administration of drugs is easily managed by ancillary care personnel [11]. Transdermal delivery and iontophoresis have the same advantages as subcutaneous infusion without the consequences of infection, but are dependent on drugs that are lipid soluble [12].…”

Section: Cutaneous and Dermalmentioning

confidence: 99%

Novel drug delivery systems

Lou

1999

Current Review of Pain

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Narcotic analgesics for chronic pain management

Cited by 8 publications

References 35 publications

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Pain management in the opioid-dependent patient

Novel drug delivery systems

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