Opioid complications and side effects.
Ramsin M Benyamin,Andrea M. Trescot,Sukdeb Datta,Ricardo M. Buenaventura,Rajive Adlaka,Nalini Sehgal,Scott E. Glaser,Ricardo Vallejo +7 more
TLDR
The role of opioids in the treatment of chronic pain is influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications, and these phenomena are the focus of this review.Abstract:
Medications which bind to opioid receptors are increasingly being prescribed for the treatment of multiple and diverse chronic painful conditions. Their use for acute pain or terminal pain is well accepted. Their role in the long-term treatment of chronic noncancer pain is, however, controversial for many reasons. One of the primary reasons is the well-known phenomenon of psychological addiction that can occur with the use of these medications. Abuse and diversion of these medications is a growing problem as the availability of these medications increases and this public health issue confounds their clinical utility. Also, the extent of their efficacy in the treatment of pain when utilized on a chronic basis has not been definitively proven. Lastly, the role of opioids in the treatment of chronic pain is also influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications. It is these phenomena that are the focus of this review. Common side effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent proper prescribing and in turn inadequate pain management. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus. The most common side effects of opioid usage are constipation (which has a very high incidence) and nausea. These 2 side effects can be difficult to manage and frequently tolerance to them does not develop; this is especially true for constipation. They may be severe enough to require opioid discontinuation, and contribute to under-dosing and inadequate analgesia. Several clinical trials are underway to identify adjunct therapies that may mitigate these side effects. Switching opioids and/or routes of administration may also provide benefits for patients. Proper patient screening, education, and preemptive treatment of potential side effects may aid in maximizing effectiveness while reducing the severity of side effects and adverse events. Opioids can be considered broad spectrum analgesic agents, affecting a wide number of organ systems and influencing a large number of body functions.read more
Citations
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A comprehensive review of opioid-induced hyperalgesia.
TL;DR: Clinicians should suspect OIH when opioid treatment's effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages.
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Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective
TL;DR: An updated 10-year perspective on therapeutic use, abuse, and non-medical use of opioids and their consequences is provided.
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Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.
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American Society of Interventional Pain Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain: Part 2 - Guidance
Laxmaiah Manchikanti,Salahadin Abdi,Sairam Atluri,Carl C. Balog,Ramsin M Benyamin,Mark V. Boswell,Keith R. Brown,Brian Mendoza Bruel,David A. Bryce,Patricia A. Burks,Allen W. Burton,Aaron K. Calodney,David Caraway,Kimberly A Cash,Paul J. Christo,Kim S Damron,Sukdeb Datta,Timothy R. Deer,Sudhir Diwan,Ike Eriator,Frank J E Falco,Bert Fellows,Stephanie Geffert,Christopher Gharibo,Scott E. Glaser,Jay S. Grider,Haroon Hameed,Mariam Hameed,Hans Hansen,Michael E. Harned,Salim M. Hayek,Standiford Helm,Joshua A Hirsch,Jeffrey W. Janata,Alan D. Kaye,Adam M. Kaye,David Kloth,Dhanalakshmi Koyyalagunta,Marion Lee,Yogesh Malla,Kavita N. Manchikanti,Carla D McManus,Vidyasagar Pampati,Allan T. Parr,Ramarao Pasupuleti,Vikram B. Patel,Nalini Sehgal,Sanford M. Silverman,Vijay P. Singh,Howard S. Smith,Lee T. Snook,Daneshvari R. Solanki,Deborah H. Tracy,Ricardo Vallejo,Bradley W. Wargo +54 more
TL;DR: A robust agreement which is followed by all parties is essential in initiating and maintaining opioid therapy as such agreements reduce overuse, misuse, abuse, and diversion.
Journal Article
Opioids in the management of chronic non-cancer pain
Andrea M. Trescot,Standiford Helm,Hans Hansen,Ramsin M Benyamin,Scott E. Glaser,Rajive Adlaka,Samir P. Patel,Laxmaiah Manchikanti,Sukdeb Datta,Nalini Sehgal,James D. Colson,Art Jordan,Marion Lee +12 more
TL;DR: The evidence for the effectiveness of long-term opioids in reducing pain and improving functional status for 6 months or longer is variable and the recommendation is 2A - weak recommendation, high-quality evidence: with benefits closely balanced with risks and burdens.
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