The pharmacological relief of pain--contemporary issues.
OBJECTIVE
To provide a general description of the pharmacological principles of pain management particularly the management of severe pain with opioid analgetic agents.


METHODS
Literature updating previous reviews by the authors in this Journal and the Proceedings of the VIth World Congress on Pain, Adelaide, 1-6 April 1990.


METHODS
Studies were selected under the subheadings: opioid receptors; endogenous opioids; development of new agents; recognition of the need to improve analgesia; pharmacokinetics and pharmacodynamics of opioids; and novel drug delivery methods.


METHODS
The extracted information was more descriptive than quantitative.


RESULTS
The pharmacological relief of pain involves treatment of patients with drugs characterised by extremely large interpatient variability in pharmacokinetics and pharmacodynamics by way of an extremely complex interaction with endogenous control mechanisms. It is not surprising that management of pain in many patients is less than adequate.


CONCLUSIONS
Although much vigorous interdisciplinary research is being undertaken to develop a scientific basis for understanding pain and analgesia, improvements in the clinical management of pain can only occur if practitioners recognise the need for individualised methods of pain relief and treat their patients accordingly.
Department of Anaesthesia and Pain Management, University of Sydney, Royal North Shore Hospital, St Leonards, NSW.
L E
LE
Mather
M J
MJ
Cousins
D000208:Acute Disease; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D016503:Drug Delivery Systems; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010149:Postoperative Pain / Q000188:drug therapy; D011957:Receptors, Opioid / Q000187:drug effects
D000700:Analgesics; D000701:Analgesics, Opioid; D011957:Receptors, Opioid