Opioids in pain medicine


      Opioids represent one of the most important classes of analgesic medication and are effective in acute and cancer pain management. Concerns exist regarding their utility in chronic non-cancer pain due to consequences of long-term use and lack of efficacy. Opioids bind to G protein-coupled receptors leading to a variety of physiological effects, including analgesia. Individual drug pharmacokinetics and pharmacodynamics, actions across different physiological systems, side-effect profiles, routes of administration and patient factors that impact on drug efficacy, all need to be considered when choosing the appropriate opioid and preparation for individual patients.


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        • Brownstein M.J.
        A brief history of opiates, opioid peptides, and opioid receptors.
        Proc Natl Acad Sci USA. 1993; 90: 5391-5393
        • Chou R.
        • Turner J.A.
        • Devine E.B.
        • et al.
        The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a national institutes of health pathways to prevention Workshop.
        Ann Intern Med. 2015; 162: 276
        • Gostin L.O.
        • Hodge J.G.
        • Noe S.A.
        Reframing the opioid epidemic as a national emergency.
        Am Med Assoc. 2017; 318: 1539-1540
        • Paul A.K.
        • Smith C.M.
        • Rahmatullah M.
        • et al.
        Opioid analgesia and opioid-induced adverse effects: a review.
        Pharmaceuticals. 2021; 14: 1-22
        • Borsodi A.
        • Bruchas M.
        • Caló G.
        • et al.
        Opioid receptors (version 2019.4) in the IUPHAR/BPS guide to pharmacology database.
        IUPHAR/BPS Guide to Pharmacology CITE. 2019;
        • McDonald J.
        • Lambert D.G.
        Opioid mechanisms and opioid drugs.
        Anaesth Intensive Care Med. 2016; 17: 464-468
        • Azzam A.A.H.
        • McDonald J.
        • Lambert D.G.
        Hot topics in opioid pharmacology: mixed and biased opioids.
        Br J Anaesth. 2019; 122: e136-e145
        • Chaves C.
        • Remiao F.
        • Cisternino S.
        • et al.
        Opioids and the blood-brain barrier: a dynamic interaction with consequences on drug disposition in brain.
        Curr Neuropharmacol. 2017; 15: 1156-1173
        • Niesters M.
        • Overdyk F.
        • Smith T.
        • et al.
        Opioid-induced respiratory depression in paediatrics: a review of case reports.
        Br J Anaesth. 2013; 110: 175-182
        • Green C.J.
        • Bagchi S.
        Techniques of opioid administration.
        Anaesth Intensive Care Med. 2019; 20: 430-435
        • Srivastava D.
        • Hill S.
        • Carty S.
        • et al.
        Surgery and opioids: evidence-based expert consensus guidelines on the perioperative use of opioids in the United Kingdom.
        Br J Anaesth. 2021; 126: 1208-1216
        • Imam M.Z.
        • Kuo A.
        • Ghassabian S.
        • et al.
        Progress in understanding mechanisms of opioid-induced gastrointestinal adverse effects and respiratory depression.
        Neuropharmacology. 2018; 131: 238-255
        • Khosrow-Khavar F.
        • Kurteva S.
        • Cui Y.
        • et al.
        Opioids and the risk of infection: a critical appraisal of the pharmacologic and clinical evidence.
        Expert Opin Drug Metab Toxicol. 2019; 15: 565-575
        • Buggy D.J.
        • Borgeat A.
        • Cata J.
        • et al.
        Consensus statement from the BJA Workshop on Cancer and Anaesthesia.
        Br J Anaesth. 2015; 114: 2-3
        • Kimmel P.L.
        • Fwu C.-W.
        • Abbott K.C.
        • et al.
        Opioid prescription, morbidity, and mortality in United States dialysis patients.
        J Am Soc Nephrol. 2017; 28: 3658-3670
        • Nerenz R.D.
        • Tsongalis G.J.
        Pharmacogenetics of opioid use and implications for pain management.
        J Appl Lab Med An AACC Publ. 2018; 2: 622-632
        • Kalso E.
        Clinical pharmacology of opioids in the treatment of pain.
        in: Sommer C. Wallace M.S. Cohen S.P. Kress M. Pain 2016: refresher courses. IASP Press, Washington D.C.2016: 449-460
        • Wagner B.K.J.
        • OʼHara D.A.
        Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients.
        Clin Pharmacokinet. 1997; 33: 426-453
        • Drewes A.M.
        • Jensen R.D.
        • Nielsen L.M.
        • et al.
        Differences between opioids: pharmacological, experimental, clinical and economical perspectives.
        Br J Clin Pharmacol. 2013; 75: 60-78