Risks and Benefits of Opioid Analgesics
This Web site discusses the appropriate use of opioid analgesics to treat patients who are experiencing moderate to severe pain.
Opioids have an important role in the treatment of some types of acute and chronic pain. Opioids, which exert their pharmacologic effects by acting as agonists at different types of opioid receptors in the body, can result in beneficial therapeutic effects, as well as in adverse events in some cases.
Clinicians need to fully weigh the anticipated benefits of opioid therapy with the possibility of adverse events, particularly in patients who have medical conditions or co-morbidities that may put them at increased risk.Adverse Events and Other Considerations
Common adverse events of opioids include sedation, confusion, nausea, vomiting, constipation, pruritus (itching), respiratory depression, and urinary retention. In general, a proactive, "pre-emptive" approach to managing adverse effects, in particular those related to bowel function, is preferred. With the exception of constipation, these side effects generally subside over time with continued use of the medication. Opioids should always be used cautiously in patients who have impaired ventilation, bronchial asthma, liver failure, or increased intracranial pressure.3
Physical dependence with long-term use of opioids should be expected. It is important to note that physical dependence is not the same as addiction.20 Physical dependence is a state of physiological adaption manifested by a withdrawal syndrome produced by abrupt discontinuation of a medication, decreasing serum concentrations of the medication, and/or the administration of an antagonist or inhibitor of the medication.3 Active measures, such as tapering the medicine when it is no longer needed, should be taken to prevent or reduce the physical and emotional manifestations of withdrawal.20
Addiction is a primary, chronic neurobiological disease with genetic, psychosocial, and environmental factors that influence its development and manifestation. Addiction is characterized by continued use of a drug despite detrimental effects and self-harm, impaired control over the use of a drug, and preoccupation with the use of a drug for non-therapeutic purposes.3
For more information about physical dependence and addiction, as well as other important definitions and terms regarding opioid analgesics, go to What a Prescriber Should Know Before Writing the First Prescription.
References Used in the Section:
- 3 National Pharmaceutical Council in collaboration with Joint Commission on Accreditation of Healthcare Organizations. Pain: Current Understanding of Assessment, Management, and Treatments. 2001; 1-29.
- 20 Gourlay, D. and H. Heit, Pain and Addiction: managing risk through comprehensive care. Journal of Addictive Diseases. 2008; 27(3):8.