Opioids remain an important cornerstone and the most effective mainstay analgesics for acute and terminal cancer pain treatments. Effective analgesia is obtained in the majority of cancer pain patients with the application of fairly straightforward rational treatment algorithms using opioids as the main therapy. A major barrier to be overcome, however, is that chronic pain is often not viewed as a physical illness worthy of treatment. Many studies demonstrating that specific changes occur in the peripheral and central nervous systems of patients with chronic pain provide the rationale for changing the approaches to chronic pain management and instituting more aggressive and comprehensive treatment. This review describes the role of opioids in the treatment of cancer pain, including a brief overview of cancer pain syndromes, essential aspects of opioid therapy, opioid pharmacology, opioid rotation, properties of the individual opioids, and management of common side effects of opioids. As understanding of the pharmacology of this class of drugs becomes more sophisticated, clinicians may anticipate dosage-limiting adverse effects and variations in individual response.
Keywords: Chronic pain, breakthrough pain, degenerative joint diseases, fibromyalgia, visceral diseases, cancer, opioids, hydromorphone, hydrocodone, oxycodone
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