What are the special considerations of opioid use for postoperative pain control when using in geriatric patients? Elderly patients suffer from conditions such as arthritis or cancer that render them more likely to undergo surgery. Their pain is often undertreated, and elderly individuals may be more vulnerable to the detrimental effects of such undertreatment. The …
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Are long acting opioid preparations preferred over short acting types? Theoretically, extended release, long-acting (ER/LA) opioids afford cancer pain relief over a longer period of time (8 to 72 hours based on the product properties), whereas the duration of action of immediate release (IR) opioids is limited to about 4 to 6 hours. There is …
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What is “opioid tolerance”? In general, tolerance to a drug occurs when, with continuous administration over time, greater amounts of that drug are required to achieve the original degree of its desired therapeutic effect. Patients will develop tolerance to both the analgesic effect as well as the side effects of opioids. To avoid the adverse …
Are opioids known to increase the risk for acute herpes zoster? Are they associated with risk for subsequent postherpetic neuralgia? The answer to both questions is no. In addition to vaccination against zoster, studies have demonstrated that early (within 72 hours of symptom or rash onset) initiation of antiviral therapy and assiduous pain management, including …
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Do nonsteroidal antiinflammatory drugs have direct tumor effects? Nonsteroidal antiinflammatory drugs (NSAIDs) are useful for tumor-induced pain, partially because of their effects on the inflammatory substrate at the tumor margins. Bone metastases require prostaglandin E2 for growth; NSAIDs inhibit prostaglandin synthesis and thus may decrease osteoblastic tumor proliferation. The use of NSAIDs is, however, limited …
What are the most common neuropathic pain conditions? The most common peripheral neuropathic pain conditions are distal symmetric painful polyneuropathy, postherpetic neuralgia (PHN), posttraumatic neuralgia (PTN), and trigeminal neuralgia. Neuropathic pain can also follow central nervous system insults, most commonly poststroke pain and spinal cord injury pain; the latter can occur in the context of …
Intrathecal drug delivery for neuropathic pain Intrathecal pumps may be used to deliver medication directly to the intrathecal space with immediate access to the spinal cord and via the cerebrospinal circulation to the brain. Typically opioids or a combination of opioids and local anesthetic are placed in a programmable reservoir located in the lower abdominal …