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Related Concept Videos

Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
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Pain serves as a critical warning signal that alerts the body to potential or actual harm. When mechanical pressure on the skin is intense, such as from a sharp pinch, the sensation transitions from touch to pain. Similarly, extreme temperatures, like a hot pot handle, convert the sensation of heat into pain. Pain can also result from overstimulation of other senses, such as blinding light, loud noise, or the intense heat from habañero peppers. This ability to sense pain is essential for...
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Opioids May be Appropriate for Chronic Pain.

Paul J Christo1

  • 1Paul J. Christo, M.D., M.B.A., is Associate Professor, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine. He earned a B.S. from University of Notre Dame, Notre Dame, IN, an M.D. from University of Louisville School of Medicine, Louisville, KY, and an M.B.A. from The Johns Hopkins Carey School of Business, Baltimore, MD.

The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
|July 8, 2020
PubMed
Summary

Opioid therapy can be a medically reasonable and ethical option for select chronic pain patients unresponsive to other treatments. This approach aims to improve function and quality of life while carefully considering potential harms.

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Area of Science:

  • Pain Management
  • Pharmacology
  • Public Health

Background:

  • Chronic pain affects millions, necessitating comprehensive treatment strategies.
  • Current guidelines for opioid therapy have faced criticism for unintended negative consequences on patient care.
  • Access to diverse therapeutic options, including judicious opioid use, is crucial for managing severe pain.

Purpose of the Study:

  • To examine the role of opioid therapy in managing chronic non-cancer pain within the context of the opioid epidemic.
  • To address criticisms of existing guidelines and explore the ethical considerations of opioid prescribing.
  • To advocate for opioid therapy as a compassionate care option for specific patient populations.

Main Methods:

  • Literature review and critical analysis of existing guidelines and their impact.
  • Examination of the ethical and medical rationale for opioid therapy in severe chronic pain.
  • Discussion of patient outcomes and physician perspectives regarding current opioid prescribing practices.

Main Results:

  • Opioid therapy may be appropriate for a subset of patients with severe chronic pain refractory to other treatments.
  • Concerns exist regarding the restrictive nature of current guidelines and their impact on patient access to care.
  • Balancing potential benefits against harms is essential for ethical opioid prescribing.

Conclusions:

  • Opioid therapy remains a viable and ethical component of pain management for carefully selected individuals.
  • Revisiting and refining guidelines is necessary to ensure patient access to necessary pain relief.
  • Compassionate and evidence-based pain care necessitates considering all appropriate therapeutic options.