Chronic pain opioids

Opioid addiction in the USA has been increasing at alarming rates. Almost two million persons aged 12 or older have used pain relievers non-medically for the first time in the past year [1], Fifty-five percent of these pain relievers were obtained from family and friends, with only 17 % having been prescribed by a doctor. In the treatment of chronic pain, opioid addiction develops in only about 3 % of those treated in general medical practice [6]. The overuse of these pain relievers may explain the upsurge in the number of heroin users that has increased from 373,000 individuals in 2007 to 620,000 in 2011. 

Fentanyi citrate Solution Chronic pain/opioid analgesic Instanyl , PecFent ... 

The major use of the narcotic analgesic is to relieve or manage moderate to severe acute and chronic pain. The ability of a narcotic analgesic to relieve pain depends on several factors, such as the drug, the dose, the route of administration, the type of pain, the patient, and the length of time the drug has been administered. Morphine is the most widely used opioid and an effective drug for... 

Opioids Mu, delta, kappa, Pain, anxiety, mood, Chronic pain, addiction... 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Chronic opiate treatment results in complex adaptations in opioid receptor signaling. Much has been learned from studies on mechanisms of tolerance to the analgesic effects of opiates. This is a major clinical problem, as it means that ever-escalating doses are required for the treatment of chronic pain. The classic view was that tolerance reflects a decrease in functional opioid receptors via desensitization and internalization. Desensitization occurs when receptors are uncoupled from G proteins as a result of phosphorylation by G-protein-coupled receptor... 

Tramadol has a side-effect profile similar to that of other opioid analgesics. It may also enhance the risk of seizures. It may be useful for treating chronic pain, especially neuropathic pain, but it has little advantage over other opioid analgesics for acute pain. 

BaUantyne JC, Mao J. Medical progress opioid therapy for chronic pain. N Engl ] Med 20(B 349 1943-53. 

Pain - Management of persistent moderate to severe chronic pain in patients requiring continuous opioid analgesia for pain that cannot be managed by lesser means such as opioid combinations, nonsteroidal analgesics, or IR opioids. 

Acute abstinence syndrome (withdrawal) - In chronic pain patients in whom opioid analgesics are abruptly discontinued, anticipate a severe abstinence syndrome. This may be similar to the abstinence syndrome noted in patients who withdraw from heroin. Severity is related to the degree of dependence, the abruptness of withdrawal, and the drug used. Generally, withdrawal symptoms develop at the time the next dose would ordinarily be given. 

Ketorolac tromethamine Ketorolac is indicated for the short-term (up to 5 days) management of moderately severe acute pain that requires analgesia at the opioid level. It is not indicated for minor or chronic painful conditions. Increasing the dose beyond the label recommendations will not provide better efficacy but will result in increasing risk of developing serious adverse events. 

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