Citation

Frederich ME, Bowen K. Clin. Pulm. Med. 2002; 9(3): 157-163.

Copyright

(Copyright © 2002, Wolters Kluwer)

DOI

10.1097/00045413-200205000-00004

PMID

unavailable

Abstract

Opioids are the best medications for managing chronic pain in patients who are approaching the ends of their lives. There are no ethical or legal barriers to prescribing these medications in therapeutic doses with the intention of relieving pain. "Opiophobia," including fear of hastening death or inducing addiction are not supportable with contemporary evidence and must be overcome for practitioners to prescribe adequate doses of opioids for appropriate patients. Strong pure opioid agonists are the medications of choice. These include morphine, oxycodone, hydromorphone, fentanyl, and methadone. Skill in rotating between the opioids and in performing accurate conversions is essential to good practice. Weaker opioids, particularly when compounded together with acetaminophen, should be avoided. There is no role for meperidine in managing chronic pain. Neither should the agonist-antagonist combinations be prescribed because of their higher incidence of psychomimetic effects. Finally, bothersome side effects of opioids may be controlled by prophylactically prescribing medications before the side effects become unmanageable. Central respiratory depression, which occurs rarely if at all with therapeutic opioid prescribing, and never without first the onset of sedation, should receive less attention and be less a cause for concern on the part of the prescribing physician.

Language: en

Keywords

analgesic agent; article; butorphanol; butorphanol tartrate; chronic pain; clinical practice; codeine; constipation; corticosteroid; dextropropoxyphene; dextropropoxyphene napsilate; dezocine; docusate sodium; drug blood level; drug choice; drug elimination; drug formulation; drug half life; drug metabolism; drug metabolite; drug potency; End of Life; Euthanasia; fentanyl; fentanyl citrate; human; hydrocodone bitartrate plus paracetamol; hydromorphone; liver toxicity; long acting drug; medical ethics; methadone; methylphenidate; modafinil; morphine; nalbuphine; nausea and vomiting; nonsteroid antiinflammatory agent; opiate; opiate addiction; opiate agonist; opiate antagonist; Opioids; oxycodone; pain assessment; Pain management; Palliative care; paracetamol; patient monitoring; pentazocine; percocet; peri colace; pethidine; Physician-assisted suicide; prescription; pruritus; psychosis; respiration depression; salicylic acid derivative; sedation; sennokot s; senokot; terminal disease; tylox; unindexed drug