Pain Centre

05 December 2008

High efficacy opioids

High efficacy opioids are mostly administered by injection. They include morphine, nalbuphine and pethidine.

They are effective against severe pain and are mostly administered by injection.

Many oral opioids are used in the treatment of chronic pain.

The nursing staff members in hospitals are mainly worried about respiratory depression which is the most dangerous side-effect of the opioids, and therefore very often administer far too little of these excellent pain killers with, as an obvious consequence, poor pain control.

Combining opioids with other pain killers like paracetamol and NSAIDs means attacking the pain on different receptors. This often decreases the patient’s opioids requirements by up to 30%, which also means less risk for side-effects, yet with improved pain relief.

An interesting finding after surgery is that strong opioids do not seem to take ordinary headache away, whereas simple paracetamol does.

Examples of strong opioids:

  • Morphine: the reference drug of the opioids - cheap and very effective

  • Pethidine

  • fentanyl (Durogesic®, Sublimaze®), sufentanyl (Sufenta®), alfentanyl (Rapifen®), remifentanyl (Ultiva®): used for intra-operative pain control
  • buprenorphine (Temgesic®): less risk for respiratory depression and abuse and dependence (addiction); however, if respiratory depression occurs, it can be severe and very difficult to counteract

  • nalbuphine (Nubaine®): less risk for respiratory depression and addiction

  • methadone (Physeptone®): often used in the treatment of opioid addiction and withdrawal

  • pentazocine (Sosegon®)

  • dipipanone (Wellconal®)

The specific use and ways of administration of the strong opioids are discussed in the chapter about pain control during and after surgery.

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Dr Raath originally specialised and worked as an anaesthesiologist in private practice. In 2008 he obtained his Fellowship In Interventional Pain Practice and since then has operated the the Pain Clinic at the Netcare Jakaranda Hospital in Pretoria which treats all forms of chronic pain.

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