Contents

Long-Term Management of Chronic Pain 318

Defining the Different Type of Opioids 321

Agonists 321

Antagonists 321

Mixed agonist-antagonists 321

The WHO Guidelines for Pain Therapy 322

Dosing of Opioids in Tumor Pain 324

Co-analgesics (Adjuvants) for Long-Term Pain Therapy with Opioids . . 330 Buprenorphine - Opioid with Unique Receptor Kinetics for Chronic Pain 334

Transdermal Patches for Use in Chronic Pain - Fentanyl TTS, Buprenorphine TDS 341

Rational for the Use of Transdermal Systems 341

Pharmacokinetics of Opioids Used in Transdermal Systems 343

Specificity of Transdermal Buprenorphine 344

Oral Transmucosal Fentanyl Citrate Stick for Treatment of

Breakthrough Pain 347

Differences in Transdermal Technology and Pharmacology of

Fentanyl and Buprenorphine 351

Change from Oral Morphine to a Transdermal Opioid 354

Rotation from Oral Morphine to Transdermal Buprenorphine 355

Commonly Observed Side-Effects in Long-Term Pain Treatment with

Opioids 357

Respiratory Depression 357

Development of Dependency in Chronic Opioid Use 358

Development of Tolerance During Long-Term Use of Opioids 361

Constipation, a Common Side Effect of Opioids 364

Nausea and Vomiting 365

Marked Sedation 366

Pruritus 366

Rotation from One Opioid to Another 366

Opioid Rotation from Morphine to Buprenorphine or Methadone 367

Oxycodone and Hydromorphone - Alternative Opioids for Pain Relief . 368

Use of Opioids in Non-malignant Pain 375

Driving Ability While Taking an Opioid for Pain Relief 377

New Options in Opioid Medication - The OROS® (Oral Osmotic Pump)

System 378

Oxytrex™ Ultra-Low Dose Opioid Antagonist Combined with

Oxycodone with Less Tolerance Development 381

Remoxy™ with ORADUR Technology, Opioid with an Abuse-Resistant

Formulation 384

Combining Oxycodone with the Opioid Antagonist Naloxone to Deter from Drug Abuse 386

Delivery of Opioids via the Lungs - The Aerosolized Liposome-

Encapsulated Fentanyl (AeroLEF™) 387

AERx® Pulmonary Delivery System for Morphine and Fentanyl 388

DUROS® Implant Technology for Chronic Pain Treatment 391

Transdur™ Sufentanil Technology with 1 Week of Opioid Release 394

Effervescent Buccal Fentanyl Tablet for Treatment of Breakthrough Pain . 396

Intrathecal DUROS® Opioid Delivery Using a Precision Miniature Catheter 397

Appendices: Duration of Action and Dosing of Opioid Analgesics 399

References 403

Natural Pain Management

Natural Pain Management

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