title: Contribution to variability in response to opioids.
abstract: Opioids are the oldest and most effective agents for the short- and long-term control of severe pain, particularly chronic cancer pain palliation. However, morphine and other opioids display wide variations in pharmacological efficacy and tolerability, and a significant number of patients are unable to achieve adequately controlled pain at doses that do not produce intolerable adverse effects. This article reviews factors that affect the efficacy and tolerability of opioid analgesics and clinical strategies for successful pain mangement.
authors.affiliation: Department of Palliative Medicine, Bristol Haematology and Oncology Centre, University of Bristol, Horfield Road, Bristol, BS2 8ED, UK. debbie.ashby@bristol.ac.uk
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Hanks
authors.forename: Colette
authors.initials: C
authors.lastname: Reid
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001682:Biological Availability; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D020714:Maximum Tolerated Dose; D009020:Morphine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis; D010098:Oxycodone / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone; D004091:Hydromorphone; D005283:Fentanyl