Saturday, June 4, 2011

Opioid analgesics : main method of treatment chronic pain syndromes in modern medicine.

The main method of treatment of acute and chronic pain syndromes in modern medicine is a systemic pharmacotherapy. The latter may be achieved by different ways of introducing the painkiller in the body (taking by mouth, rectally, sublingually, transdermally, by injection), but in any case, drug sucking, gets into the systemic circulation, and then to the place of his actions (as opposed to of regional method of introducing an analgesic, such as perineural, epidural).
For the treatment of pain of low intensity according to WHO recommendations using different non-opioid analgesics, and pain at moderate and high intensity - opioid analgesics. Non-opioid analgesia funds have predominantly peripheral action at the source of pain, have a small analgesic potential and therefore only suitable for removing mild pain. Opioids are centrally acting analgesics, implemented via an endogenous opioid system of the body at the level of the spinal cord and brain by inhibiting the ascending flow of pain impulses. They differ from each other analgesic potential and the ability to arrest the moderate or severe pain. Thanks to good analgesic properties of opioids are widely used in various fields of medicine dealing with the intense pain - particularly in oncology and surgery.
Agonist properties (sigma) receptor has ketamine, wherein a moderate analgesic effect and the whole complex of activating side effects (tachycardia, hypertension, psychomotor agitation).
Opioid antagonist naloxone, all groups is quickly neutralize their effects, including analgesia.
Existing opioid analgesics differ not only in the interaction with specific opioid receptors, but also the characteristics of binding to them in strength and duration. The higher the affinity of opioid receptor, the stronger analgesia, a longer relationship with the receptor, the analgesia is longer.
The choice of opioid for the treatment of pain of moderate or high intensity
An important consequence of the above analysis of mechanism of action of opioids is a common position on a leading role in opioid pain therapy analgesics belonging to the class of opioid agonists, since the preparations of all other groups have some kind of restriction (the effect of a ceiling analgesic dose, antagonism toward the most potent analgesics morphine group, the undesirable side properties). This provision is particularly important when treating chronic pain, to get the best result of anesthesia and to avoid possible failures.
Range of existing opioid agonists is quite broad and includes, as noted above, analgesics of different potencies, ability to manage moderate to severe pain, and indications for treatment of such pain exist in different areas of medicine.
When shown the appointment of opioid analgesics for pain relief and how to select an opioid? To do this, first of all must be guided by certain general rules.
- Testimony to the appointment of an opioid arise when non-opioid analgesics treatment does not resolve the pain, ie pain greater than the degree of the weak. In the treatment of chronic pain in cancer patients should be preferred opioid agonists.
- When determining the intensity of pain should be guided by a simple verbal scale ratings of pain (SHVO): 0 - no pain, 1 point - mild, 2 points - moderate, 3 points - severe, 4 points - the most severe pain. For the treatment of pain of moderate or high intensity in Russia Health Ministry guidelines recommend: tramadol, prosidol to moderate pain, buprenorphine for severe pain and morphine or fentanyl (including transdermal form) for the most severe pain.
- The right to use of opioid analgesics related to drugs, doctors are committed to working with drugs (most often in the oncology and surgical facilities).
- Opioids - nenarkotiki, ranked by potent drugs (tramadol, butorphanol, nalbuphine) can be written on the prescription form for the potent means of any doctor in consultation with the head of the department, if necessary relieve the patient's pain, does not eliminate non-opioid analgesics (articular, neurogenic, and other non-cancer pain). Among the opioid agonist-only drug nenarkotikom is tramadol.

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