Opioid Duration

The duration of therapy has a huge impact on the approach to treating a patient's pain. When used in the acute pain setting, opioids can potentially obscure the progress of the disease or the location or intensity of pain. Goals of therapy are relief of sufferings without the development of adverse side effects such as decreased respiratory ventilation, reduced bowel motility, and urinary retention. Undertreatment can result in an increase in adrenocorticotropic hormone, cortisol, catecholamines, and interleukin (IL)-1 release along with sodium and water retention. Additionally, atelectasis, impaired ventilation, coronary vasoconstriction, decreased venous emptying, decreased intestinal motility, and urinary retention can be seen with inadequate pain management. Further, undertreatment of acute pain can lead to the development of certain chronic pain states (Tollison 2002).

In recent years, the chronic management of pain has emerged as a unique aspect of medicine. Medications with long half-lives are often used in the treatment of patients with chronic pain. Long-term treatment with opioids requires an opiate contract signed by the patient and the practitioner. Frequently, these patients suffer from pain associated with musculoskeletal conditions or malignancy. Patients with musculoskeletal pain often require treatment with analgesics for either intermittent pain exacerbations or constant disabling pain. Continued opioid treatment in these patients must be contingent on treatment compliance and achievement of functional improvement goals (Marcus 2005). Opiates are also used in the treatment of patients suffering chronically from pain arising from malignancy. Opioids are not indicated in all cases of terminal illness, but the analgesia, tranquility, and even the euphoria afforded by the use of opioids can potentially make the final days far less distressing for the patient and family (Ballantyne 2009). Achieving and sustaining an acceptable quality of life is a desired endpoint in the treatment of patients with chronic pain.

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