INFO - The use of long-acting opioids in chronic pain management

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Nurs Clin North Am. 2003 Sep;38(3):435-45.

The use of long-acting opioids in chronic pain management.

Vallerand AH.

Wayne State University College of Nursing, 5557 Cass Avenue, Cohn Bldg.

#364, Detroit, MI 48202, USA. April.Vallerand@...

The consensus statement from the American Pain Society and American Academy

of Pain Medicine states that the undertreatment of pain is unjustified [6].

It has been suggested that opioid therapy can be used effectively to treat

noncancer pain in a subset of patients [26], and this is becoming more

acceptable [3]. Providing sustained analgesia is an important aspect of

therapy, and medications should be administered on an around-the-clock

basis, because regular administration of doses maintains a constant level of

drug in the body and helps prevent recurrence of pain. Ideal treatment for

persistent pain is a long-acting opioid administered around the clock to

prevent baseline pain, with the use of short-acting opioids as supplemental

agents for breakthrough pain. Controlled-release formulations can lessen the

inconvenience associated with around-the-clock administration of

short-acting opioids. Sustained analgesia also can be achieved with

transdermal fentanyl, which combines a strong opioid with a 72-hour release

profile and the benefits of a parenteral route, avoiding first-pass

metabolism. Controlled-release formulations of morphine and oxycodone are

available in the United States, and hydromorphone preparations are being

reviewed for approval. Clinical experience with these formulations and

transdermal fentanyl indicates that these agents are equally effective in

controlling pain. Studies have demonstrated improved quality of life with

the transdermal route and with controlled-release morphine and oxycodone.

Because of patch reapplication every 72 hours, the transdermal route also

enhances compliance. Use of an opioid without the need for oral or

intravenous administration and the opportunity to improve compliance are

among the advantages of the transdermal route in clinical practice. The

nurse has an important role in the management of patients receiving

long-acting opioids for chronic noncancer pain, Facilitation of the

conversion from short-acting to long-acting opioids may be the initial step.

Individualization of therapy to determine which route and product best suits

the patient's needs and lifestyle can be accomplished through a

comprehensive nursing assessment. Titration of dose along with institution

of a short-acting opioid for break-through pain may require frequent

interventions that a nurse familiar with the patient can provide. Prevention

and management of opioid-related adverse events are essential for effective

opioid therapy. Providing patient and family education regarding

administration, monitoring, and management of opioid therapy is an important

nursing role. Lastly, documentation of pain level, functional status, and

opioid-related adverse events is required for each contact with the patient,

to make this information available to all who assist in the management of

the patient's pain. Chronic noncancer pain is an experience that affects all

aspects of a patient's life. Effective pain management with long-acting

opioids may help the patient to focus on the positive aspects of life,

decreasing the focus on pain.

PMID: 14567201

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

4567201 & dopt=Abstract

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