Improving opioid effectiveness: from ideas to evidence.
Opioid effectiveness can be improved by individualizing dosing, route of administration and the drug. Particularly in the treatment of chronic non-cancer pain, careful patient selection is essential. The current review concentrates on new ideas about improving opioid effectiveness by increasing efficacy or reducing adverse effects by combining other drugs that modulate opioid receptor mediated effects. These pharmacological "oipioid adjuvants" include e.g. alpha(2)-adrenergic agonists, non-steroidal anti-flammatory analgesics, NMDA-receptor antagonists, CCK-antagonists, gabapentinoids and NK-1 receptor antagonists. The theoretical background and the clinical evidence of these combinations will be discussed.
Kalso
Eija
E
Department of Anaesthesia and Intensive Care Medicine, Pain Clinic, Helsinki University Central Hospital, P.O. Box 340, FIN-00029 HUS, Finland. eija.kalso@helsinki.fi
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage; D006801:Humans; D009292:Narcotic Antagonists / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy*; D011949:Receptors, Cholecystokinin / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018691:Excitatory Amino Acid Antagonists; D009292:Narcotic Antagonists; D011949:Receptors, Cholecystokinin