Pharmacology of opioid analgesia: Clinical principles

Research output: Chapter in Book/Report/Conference proceedingChapter

10 Citations (Scopus)

Abstract

Introduction According to the World Health Organization (WHO) guidelines, opioid analgesics are the mainstay of analgesic therapy and are classified according to their ability to control mild to moderate pain (codeine, dihydrocodeine, tramadol, dextropropoxyphene [DPP]) (second step of the WHO analgesic ladder) and to control moderate to severe pain (morphine, methadone, oxycodone, buprenorphine, hydromorphone, fentanyl, heroin, levorphanol, oxymorphone) (third step of the WHO analgesic ladder). Opioid analgesics may be associated with nonopioid drugs such as paracetamol or with nonsteroidal anti-inflammatory drugs (NSAIDs) and to adjuvant drugs. The current recommended management of cancer pain consists of the regular administration of opioids and intermittent rescue doses of opioids or NSAIDs for excess pain. Individualized pain management should take into account the onset, type, site, duration, intensity, and temporal patterns of the pain (from this, it is often possible to define the cause of the pain), concurrent medical conditions, and, above all, the subjective perception of the intensity of pain that is not proportional to the type or to the extension of the tissue damage but depends on the interaction of physical, cultural, and emotional factors. Oral opioid administration remains the preferred route. However, in some clinical situations, such as vomiting, dysphagia, or confusion, or in cases in which rapid dose escalation is necessary, oral administration may be impossible, and alternative routes must be implemented. Table 11.1 shows the potential application of the different routes of opioid administration in clinical practice.

Original languageEnglish
Title of host publicationCancer Pain: Assessment and Management, Second Edition
PublisherCambridge University Press
Pages195-229
Number of pages35
ISBN (Print)9780511642357, 9780521879279
DOIs
Publication statusPublished - Jan 1 2009

Fingerprint

Analgesia
Opioid Analgesics
Pharmacology
Pain
Analgesics
Pharmaceutical Preparations
Oral Administration
Oxymorphone
Anti-Inflammatory Agents
Levorphanol
Hydromorphone
Dextropropoxyphene
Oxycodone
Tramadol
Confusion
Codeine
Buprenorphine
Pain Perception
Aptitude
Methadone

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ripamonti, C. I., & Bareggi, C. (2009). Pharmacology of opioid analgesia: Clinical principles. In Cancer Pain: Assessment and Management, Second Edition (pp. 195-229). Cambridge University Press. https://doi.org/10.1017/CBO9780511642357.012

Pharmacology of opioid analgesia : Clinical principles. / Ripamonti, Carla Ida; Bareggi, Claudia.

Cancer Pain: Assessment and Management, Second Edition. Cambridge University Press, 2009. p. 195-229.

Research output: Chapter in Book/Report/Conference proceedingChapter

Ripamonti, CI & Bareggi, C 2009, Pharmacology of opioid analgesia: Clinical principles. in Cancer Pain: Assessment and Management, Second Edition. Cambridge University Press, pp. 195-229. https://doi.org/10.1017/CBO9780511642357.012
Ripamonti CI, Bareggi C. Pharmacology of opioid analgesia: Clinical principles. In Cancer Pain: Assessment and Management, Second Edition. Cambridge University Press. 2009. p. 195-229 https://doi.org/10.1017/CBO9780511642357.012
Ripamonti, Carla Ida ; Bareggi, Claudia. / Pharmacology of opioid analgesia : Clinical principles. Cancer Pain: Assessment and Management, Second Edition. Cambridge University Press, 2009. pp. 195-229
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