__________________ Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition
Key Opioid-Related Terms
THE CHALLENGE OF PAIN MANAGEMENT Caring for patients in pain requires carefully balancing benefits of treatment with potential for harm. Opioids, one of the most commonly used classes of pain medications, are central to national efforts to stem the epidemic of opioid-related abuse, addiction, and overdose. In 2021, 106,699 drug overdose deaths occurred in the United States, the highest level of overdose deaths ever [1]. Nearly 88% of opioid-involved overdose deaths involved synthetic opioids, and more than one million people have died since 1999 from overdose. (See Figure 1.) Opioid use disorder (OUD, opioid addiction) affects over 16 million globally and 2.1 million in the United States [4]. In 2018, overdoses involving opioids killed nearly 47,000 people; 32% involved prescription opioids. The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health estimated 10.1 million people aged 12 and older misused opioids in 2019 and approximately 80% of heroin users started after using oral opioid analgesics (prescribed or illicit) [1].
Opioid: any psychoactive chemical resembling morphine, including opiates, and binding to opioid receptors in the brain. This term describes opioid and opiates. Opiate : “ natural” opioids derived from the opium poppy (e.g., opium, morphine, heroin). Semi-synthetic opioids : analgesics containing both natural and manufactured compounds (e.g., oxycodone, hydrocodone, hydromorphone, oxymorphone). Synthetic opioids : fully-human-made compounds (e.g., methadone, tramadol, and fentanyl). Although the rates of opioid prescriptions have leveled off or declined slightly in recent years, the average days of supply per opioid prescription has risk [5]. Opioids are actually not very effective for relieving chronic noncancer pain in the long term and may be associated with increased pain, reduced functioning, and physical opioid dependenc [6][7]. There is an expanding range of both nonopioid medications and nonpharmacological therapies shown to be effective in reducing many common chronic pain conditions. (See box.) This course discusses the management of chronic and acute pain in a variety of patient populations. It reviews evidence for nonopioid therapies, including nondrug and nonopioid drug options, as well as current evidence regarding opioid efficacy, harms, and overdose prevention with naloxone, and how to slowly and safely taper opioid doses.
FIGURE 1. OPIOID-RELATED OVERDOSE DEATHS BY TYPE IN THE UNITED STATES
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