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Potential Benefits of Opioid Therapy
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Potential Risks of Opioid Therapy
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PEG Tool
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ORT Tool
COMM Tool
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Analgesia
- Not all patients derive benefit
Functional status
- Mixed evidence on improvements in functional status
- Limitations of evidence: pharmaceutical sponsored trials, short duration, limited population without co-morbidities or oc-occurring addiction.
- SMART Goals
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Adverse Effects
- Sedation and Respiratory Depression
- Opioid tolerance to these side effects over time.
- Over-sedation occurs before respiratory depression.
- Sleep apnea increases risks of opioid therapy. Opioids worsen untreated sleep apnea.
- Constipation
- Tolerance does NOT occur with respect to constipation.
- Physical dependence:
- Withdrawal symptoms will occur if the drug is stopped or tapered too quickly in cases of daily, high dose opioids.
- Worsening pain
- Withdrawal-mediated pain
- Opioid-induced hyperalgesia in some patients (mechanism unknown).
- Allergies and organ toxicity
Aberrant Behavior
- Addiction
- Unknown incidence among patients prescribed opioids.
- Overdose
- Collateral risks
- Ex. ingestion and overdose by young children.
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Sources:
Benyamin R, et al. Opioid complications and side effects. Pain Physician 2008; 11:S105-S120.
Brush DE. Complications of long-term opioid therapy for management of chronic pain: the paradox of opioid-induced hyperalgesia. J Med Toxicol. 2012 Dec; 8 (4): 387-92.
Furlan AD, et al. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006 May 23; 174(11):1589-94.
Kalso E, et al. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004 Dec; 112(3):372-80.
Lee M, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14;145-161.
Schug SA, et al. Adverse effects of systemic opioid analgesics. Drug Saf 1992; 7(3):200-213.
