Opioid requirements and responses in Asians

The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. Much of the pharmacogenetic work has focused on the metabolism of codeine, morphine and pethidine, and there are some differences between Chinese and Caucasians. Asians may receive less analgesia because they are more likely to experience, or are less tolerant of the adverse effects of opioids. Despite this, ethnic factors are probably only a small contributor to the inter-individual variation in opioid requirements. Unlike earlier studies, recent larger studies using patient-controlled analgesia have shown similar opioid usage between Asians and Caucasians in the postoperative period. An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.