Opioid analgesics : dependence can be observed in at least three types of patients.

To reduce the risk of psychological dependence with opioid analgesics is recommended:

• conduct preliminary testing of patients before treatment;

• include narcotic analgesics in the complex therapy of pain syndrome, putting them together with etiopathogenetic drugs (NSAIDs, muscle relaxants, anticonvulsants, etc.);

• Regularly monitor the effectiveness of treatment.

By narcotic potential, ie ability to cause drug dependence opioid analgesics are divided into non-narcotic and narcotic. For non-narcotic opioid tramadol hydrochloride classified, butorfenola tartrate and nalbuphine chlorine.

First, apparently, a small portion of patients with chronic pain syndromes (eg, diseases of the spine, joints, skeletal muscle) are periodically assigned to them abusing painkillers. A case in point, of course, not talking about the pain in life-threatening illness or terminal conditions, when high doses of opioids may be indicated. If you formed a physical dependence, then the abolition of the pain will increase, contributing to continued drug use.
By taking a few precautions can prevent the formation of physical opioid dependence in patients with chronic pain, especially in those who abused opioids in the past:
- The purpose of the appointment of opioids - to ease the debilitating effects of pain, but keep in mind that completely eliminate the discomfort is not always possible.
- By all means necessary to achieve the active participation of patients in treatment, adjust it to improve.
- Analgesics should be considered only one component of Comrade treatment and given by mouth, preferring the least powerful drug that can ease the pain (eg, ibuprofen, or, if necessary, dextropropoxyphene).
- All appointments must coordinate a doctor.
- Showing psychotherapy (muscle relaxation, meditation), and carefully chosen exercises aimed at increasing patient and reduce pain.
- Finally, you can use non-drug treatments such as percutaneous electroneurostimulation at pains in muscles and joints.

Many addicts against the background of continued opioid abuse and other substances. Two of these substances aggravates the course of opioid most often. Firstly, it is alcohol, the classic tool is used to alleviate withdrawal symptoms, to enhance the euphoria and the replacement of the drug in the absence thereof (including the treatment of opioid dependence, such as methadone). This type of drinking, often meets the criteria for alcohol dependence, observed in one time or another in about half of those with dependence on opioids. The second substance - cocaine, which consume roughly the same reasons that alcohol, and often administered iv together with opioids (a mixture called "speedball"). Ability to alcohol, cocaine and other dependence should be considered when treating and rehabilitating persons with dependence on opioid analgesics.