Opioid in pain

Gaveriaux-Ruff, G. and Kieffer, B. Opioid receptors Gene structure and function, in Opioids in pain control. Basic and clinical aspects, edited by C. Stein, 1999, Cambridge University Press, Cambridge. 

Stein, C. Opioids in pain control. Basic and clinical aspects, 1999, Cambridge University Press, Cambridge. 

Roques BP, Noble F, Fournie-Zaluski MC. In Stein C, ed. Opioids in Pain Control Basic and Clinical Aspects. New York Cambridge University Press, 1999 21 15. 

C. Stein, Ed., Opioids in Pain Control Basic and Clincial Aspects, Cambridge University Press, Cambridge, 1999. This book contains several chapters discussing the clinical use of opioids in different types of pain and clinical settings in addition to chapters discussing the pharmacology of opioids. 

McQuay, H. Opioids in pain management. Lancet 1999, 353 (i9171), 2229-2234. 

Finally, there is little or no clinical evidence that morphine causes psychological dependence or drug-seeking behaviour, tolerance or problematic respiratory depression in patients. These events simply do not occur when opioids are used to control pain. The reason is likely to be that the actions of morphine and the context of its use in a person in pain are neurobiologically quite different from the effects of opioids in street use. These actions of opioids are described in more detail in Chapter 23. 

The mechanisms of pain and the ability to control pain may vary in different pain states. This is of particular importance in consideration of a rational basis for the treatment of both inflammatory and neuropathic pain where the damage to tissue and nerve leads to alterations in both the peripheral and central mechanisms of pain signalling. In respect of existing drug therapies, this plasticity, the ability of the system to change in the face of a particular pain syndrome, explains the effectiveness of NSAIDs in inflammatory conditions and yet is also responsible for some of the limitations in the effectiveness of opioids in neuropathic pain. 

The role of NSAIDs and opioids in chronic non-malignant pain has been discussed however, a review of adjuvant agents... 

Blake AD, Bot G, Reisine T. Molecular pharmacology of the opioid receptors. In Molecular Neurobiology of Pain. Progress in Pain Research and Management, Vol. 9 (Borsook D, ed), International Association for the Study of Pain Press, USA, 1997 259-273. 

Data from American Pain Society. Prinaples of Analgesic Use in the Treatment of Acute Pain and Chronic Cancer Pain, 5th ed. Glenview, IL American Pain Society, 2003 and Ready BL. Regional analgesics with intraspinal opioids. In Loeser JD, Butler SH, Chapman CR, etal, eds. Bonica s Management of Pain. Philadelphia Lippincott Williams 8 Wilkins, 2000 1953-1966. 

Alternative products to diclofenac include naproxen and mefenamic acid, both of which are non-steroidal anti-inflammatory drugs. Co-codamol is a mixture of the opioid analgesic codeine and paracetamol and it does not possess the anti-inflammatory component. It may be used in pain management either where NSAIDs are contraindicated or in patients who are intolerant to the effects of NSAIDs. 

The causes and mechanisms of chronic pain syndromes are diverse (Lance 8c McLeod, 1981). A similarity with depression has been noted by several authors and it has been suggested that chronic pain syndromes might result from reduced activity in serotonergic systems involved in pain suppression and mood control (Moldofsky, 1982). Other authors have suggested that a causative factor in chronic pain syndromes might be abnormally low concentrations or activity of endogenous opioids, particularly beta-endorphin (Lip-man et al., 1990). 

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