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.

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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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Links:
Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy

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