Opioide bei muskuloskelettalen Schmerzen

Abstract

Opioids are the most potent analgesics available and are well established for the treatment of severe acute, surgical and cancer pain. Due to their high effectiveness, their use in chronic non-cancer pain (CNCP) is being propagated. However, the use of opioids is still controversial due to their side effects, such as tolerance, addiction or withdrawal, and administrative difficulties associated with their prescription. Chronic rheumatic diseases, in particular low back pain and arthritis, are the leading causes of CNCP. The present article provides a brief overview of the role of opioids in chronic rheumatic diseases, pointing out that a national guideline for opioid use in CNCP is expected at the end of 2008. Furthermore, the peripheral effects of opioids on pain and inflammation in rheumatic diseases will be outlined.

Pain in Rheumatic Diseases

“…However, side effects and potential addiction have previously restricted their use in pain therapy. Therefore opioid therapy should only be prescribed within a multimodal pain control concept in advanced inflammatory or degenerative disease if other analgesics are ineffective (Pierer et al, 2010;Siegel et al, 2008). Long term, controlled and randomized studies concerning opioid use in rheumatic diseases are lacking.…”

“…In clinical practice a positive effect on sleep and musculoskeletal function especially in neuropathic pain, rheumatoid arthritis, osteoarthritis and low back pain can be observed (Pierer et al, 2010;Siegel et al, 2008). Opioids bind to opioid receptors found in the central and peripheral nervous system (Kimura & Walco, 2007, Lang et al, 2010Siegel et al, 2008). Studies confirm that opioids show mild anti-inflammatory effects (reviewed in Kimura & Walco 2007).…”

“…Therefore long term therapy is not recommended. In chronic nonmalignant pain only mild pain reduction is observed whereas functional outcome (unemployment, necessity of health care) is declining (Siegel et al, 2008). Pain intensity, vital parameters, musculoskeletal function, possible addiction and side effects have to be controlled regularly (Pierer et al, 2010;Winfield, 2008).…”

Insights and Perspectives in Rheumatology

“…Long term, controlled and randomized studies concerning opioid use in rheumatic diseases are lacking. In clinical practice a positive effect on sleep and musculoskeletal function especially in neuropathic pain, rheumatoid arthritis, osteoarthritis and low back pain can be observed (Pierer et al, 2010;Siegel et al, 2008). Opioids bind to opioid receptors found in the central and peripheral nervous system (Kimura & Walco, 2007, Lang et al, 2010Siegel et al, 2008).…”

“…Therefore long term therapy is not recommended. In chronic nonmalignant pain only mild pain reduction is observed whereas functional outcome (unemployment, necessity of health care) is declining (Siegel et al, 2008). Pain intensity, vital parameters, musculoskeletal function, possible addiction and side effects have to be controlled regularly (Pierer et al,  they have to learn to do that independently from the support team which was available to them in their childhood, e.g.…”