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Treatment of Postherpetic Neuralgia: The Role of Opioids

  • Jane C. Ballantyne
Chapter

Abstract

In many clinical situations, there is no medication that controls pain better than an opioid. Its effects are immediate, based in key areas of the central nervous system that process pain, and produce a dose-dependent reduction in pain intensity whatever the source or type of pain. Thus, opioids have a time-honored place in the treatment of severe acute pain and in the treatment of pain at the end of life. In these situations, other medications can be used as adjuncts, to improve pain relief and reduce opioid doses, but there is no complete substitute for an opioid that will effectively and quickly reduce pain’s intensity and render pain tolerable. Medicine has come to accept the supreme role for opioids for treating severe time-limited pain and the duty of clinicians to provide opioids in such a situation. What is much more difficult is what the role is for opioids in treating pain that is not time limited – chronic pain. It is always tempting to want to prolong opioid therapy on the basis that its early effects are dramatic; neither patients nor providers want to go back to pain remembered from before opioids were initiated. And it has been argued recently that centuries’ old caution about opioids’ addictive properties was not justified and should not interfere with attempts to relieve pain, even chronic pain.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA

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