[Current principles of the clinical use of central-action analgesics]

The author analyzes the results of experimental and clinical studies of various central action analgesics used for total anesthesia, postoperative analgesia, and chronic pain relief in cancer patients. General shortcomings of all opioid analgesics were revealed: analgesias not always full-value because of different individual sensitivity to opioids, and side effects were often serious. The latest progress of the fundamental sciences in research of the mechanisms of pain and body responses related to pain helped improve the available and develop new more effective methods for total anesthesia and postoperative analgesia on the basis of opioid analgesics with the use of special nonopiate components compensating for the defects of opiate analgesia: clofelin, an adreno-positive agent; acelysin and contrykal, prostaglandin and kinin synthesis inhibitors. Synthetic opioids of the latest generation (buprenorphine, tramadol) were found preferable in the treatment of chronic pain in cancer vs. morphine and its analogs; an alternative scheme of drug therapy of chronic pain on the basis of these drugs is offered which is highly effective and causes the minimal side effects.