Skip to main content
SpringerLink
Log in

Opioids

  • Chapter
  • First Online:
Academic Pain Medicine

  • 1319 Accesses

Abstract

Opioids have been used for the treatment of pain for thousands of years. Numerous semisynthetic and synthetic compounds have now been formulated to complement the naturally occurring opioids. The lack of compelling evidence of the utility of opioids in the management of chronic nonmalignant pain coupled with well-known risks such as addiction, overdose, and death raises questions about the place of these medications in the contemporary paradigm of pain management. Careful patient selection and close monitoring are essential when opioids are used in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 59.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378–82.

    Article  Google Scholar 

  2. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016. https://doi.org/10.15585/mmwr.mm655051e1.

  3. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. JAMA. 2016;315(15):1624–45.

    Article  CAS  Google Scholar 

  4. Messlinger K. Functional morphology of nociceptive and other fine sensory endings (free nerve endings) in different tissues. In: Kumazawa T, Kruger L, Mizumura K, editors. The polymodal receptor—a gateway to pathological pain. Progress in brain research, vol. 113. Amsterdam: Elsevier; 1996. p. 273–98.

    Chapter  Google Scholar 

  5. Cervero F. Sensory innervation of the viscera: peripheral basis of visceral pain. Physiol Rev. 1994;74:95–138.

    Article  CAS  Google Scholar 

  6. Ness TJ, Gebhart GF. Visceral pain: a review of experimental studies. Pain. 1990;41:167–234.

    Article  CAS  Google Scholar 

  7. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain. 1993;54:241–89.

    Article  CAS  Google Scholar 

  8. Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain. 1993;55:5–54.

    Article  CAS  Google Scholar 

  9. Heppelmann B, Messlinger K, Neiss WF, et al. Ultrastructural three-dimensional reconstruction of group III and group IV sensory nerve endings (“free nerve endings”) in the knee joint capsule of the cat: evidence for multiple receptive sites. J Comp Neurol. 1990;292:103–16.

    Article  CAS  Google Scholar 

  10. Carlton SM, Zhou S, Coggeshall RE. Localization and activation of substance P receptors in unmyelinated axons of rat glabrous skin. Brain Res. 1996;734:103–8.

    Article  CAS  Google Scholar 

  11. Coggeshall RE, Zhou S, Carlton SM. Opioid receptors on peripheral sensory axons. Brain Res. 1997;764:126–32.

    Article  CAS  Google Scholar 

  12. Barash PG, Cullen BF, Stoelting RK. Handbook of clinical anesthesia. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. Chapter 19

    Google Scholar 

  13. Keiffer BL. Opioids: first lessons from knockout mice. Trends Pharmacol Sci. 1999;20:19–26.

    Article  Google Scholar 

  14. Hassan AHS, Ableitner A, Stein C, et al. Inflammation of the rat paw enhances axonal transport of opioid receptors in the sciatic nerve and increases their density in the inflamed tissue. Neuroscience. 1993;55:185–95.

    Article  CAS  Google Scholar 

  15. Stein C, Pfluger M, Yassouridis A, et al. No tolerance to peripheral morphine analgesia in presence of opioid expression in inflamed synovia. J Clin Invest. 1996;98:793–9.

    Article  CAS  Google Scholar 

  16. Besse D, Lombard MC, Zajac JM, et al. Pre- and post-synaptic distribution of mu, delta and kappa opioid receptors in the superficial layers of the cervical dorsal horn of the rat spinal cord. Brain Res. 1990;521:15–22.

    Article  CAS  Google Scholar 

  17. Wirz S, Wittmann M. Gastrointestinal symptoms under opioid therapy: a prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine. Eur J Pain. 2009;13(7):737–43.

    Article  CAS  Google Scholar 

  18. Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332–43.

    Article  CAS  Google Scholar 

  19. Thorn SE, Wickbom G, Philipson L, et al. Myoelectricactivity in the stomach and duodenum after epidural administration of morphine or bupivacaine. Acta Anaesthesiol Scand. 1996;40:773–8.

    Article  CAS  Google Scholar 

  20. Mahajan G, Wilsey B, Fishman SM. Opioid therapy: adverse effects including addiction. In: Benzon HT, Raja SN, Molloy RE, et al., editors. Essentials of pain and regional anesthesia. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 94–105.

    Chapter  Google Scholar 

  21. Candy B, Jones L, Goodman ML, Drake R, Tookman A. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev. 2011;1:CD003448.

    Google Scholar 

  22. Golembiewski J. Morphine and hydromorphone for postoperative analgesia: focus on safety. J Perianesth Nurs. 2003;18(2):120–2.

    Article  Google Scholar 

  23. Centers for Disease Control and Prevention. J Pain Palliat Care Pharmacother. 2016;14(2):138–40.

    Article  Google Scholar 

  24. Inturrisi CE. Clinical pharmacology of opioids for pain. Clin J Pain. 2002;18(4 Suppl):S3–13.

    Article  Google Scholar 

  25. Christrup LL. Morphine metabolites. Acta Anaesthesiol Scand. 1997;41:116–22.

    Article  CAS  Google Scholar 

  26. Tiseo PJ, Thaler HT, Lapin J, et al. Morphine-6-glucuronide concentrations and opioid-related side effects: a survey in cancer patients. Pain. 1995;61:47–54.

    Article  Google Scholar 

  27. Lurcott G. The effects of the genetic absence and inhibition of CYP2DA on the metabolism of codeine and its derivatives, hydrocodone and oxycodone. Anesth Prog. 1998;45(4):154–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Ercoli N, Lewis MN. The Time-Action curves of morphine, codeine, dilaudid, and Demerol by various methods of administration. J Pharmacol Exp Ther. 1945;84(4):301–17.

    CAS  PubMed  Google Scholar 

  29. Kirchheiner J. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication. Pharmacogenomics J. 2007;4(7):257–75.

    Article  Google Scholar 

  30. Pasternak G. Pharmacological mechanisms of Opioid Analgesics. Clin Neuropharmacol. 1993;16(1):1–18.

    Article  CAS  Google Scholar 

  31. Angst MS, Drover DR. Pharmacodynamics of orally administered sustained- release hydromorphone in humans. Anesthesiology. 2001;94(1):63–7.

    Article  CAS  Google Scholar 

  32. Kaplan HL, Busto UE. Inhibition of cytochrome P450 2D6 metabolism of hydrocodone to hydromorphone does not importantly affect abuse liability. J Pharmacol Exp Ther. 1997;281(1):103–8.

    CAS  PubMed  Google Scholar 

  33. Kullgren J, Le V. Incidence of hydromorphone-induced neuroexcitation in hospice patients. J Palliat Med. 2013;12(10):1205–9.

    Article  Google Scholar 

  34. American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain. 4th ed. Glenview: American Pain Society; 1999.

    Google Scholar 

  35. Mahajan G, Fishman SM. Major opioids in pain management. In: Benzon HT, Raja SN, Molloy RE, et al., editors. Essentials of pain and regional anesthesia. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 94–105.

    Chapter  Google Scholar 

  36. Fukada K. Chapter 27. Opioids. In: Miller RD, Eriksson I, Fleisher L, et al., editors. Miller’s anesthesia. 7th ed. Philadelphia: Churchill-Livingstone; 2009.

    Google Scholar 

  37. Benzon HT, Raja SN, Liu SS, et al. Essentials of pain medicine. 4th ed. Philadelphia: Elsevier; 2018. Chapter 42.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA

    Kristoffer Padjen, Scott Maddalo, Patrick Milord, Chaim Goldfeiz, Robert Otterbeck & Christopher Gharibo

Authors
  1. Kristoffer Padjen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Maddalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Milord
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chaim Goldfeiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Otterbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher Gharibo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristoffer Padjen .

Editor information

Editors and Affiliations

  1. Pain Medicine Fellowship, Department of Anesthesiology, Perioperative and Pain Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Yury Khelemsky

  2. Pain Medicine Fellowship, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anuj Malhotra

  3. Regional Anesthesia and Acute Pain Medicine Fellowship, Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Karina Gritsenko

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Padjen, K., Maddalo, S., Milord, P., Goldfeiz, C., Otterbeck, R., Gharibo, C. (2019). Opioids. In: Khelemsky, Y., Malhotra, A., Gritsenko, K. (eds) Academic Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-18005-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-18005-8_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18004-1

  • Online ISBN: 978-3-030-18005-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation