The Safe and Rational Use of Analgesics: Opioid Analgesics

Purpose of the Review The safe and effective treatment of acute pain is a complex and challenging area for clinicians. In this review we use three cases describing common clinical scenarios to discuss the safe and appropriate use of opioid analgesics. Review Findings Opioids are effective and can be used safely for the treatment of acute pain, but have predictable and dose dependent adverse effects. As the dose of opioid increases, respiratory depression, somnolence, and confusion become predominant adverse effects. As the duration of the treatment increases, their safety and effectiveness decreases. In general, a patient that requires regular opioid treatment for more than 5 days will require dose tapering to avoid withdrawal symptoms. Opioids are generally not considered safe for the treatment of mild pain, and their use for chronic pain is controversial. Summary Opioid medications represent a safe and effective approach to the treatment of acute pain. Their safe use requires monitoring for and treatment of their adverse effects. The best approach for using opioids is to select the opioid with the onset, duration, and adverse effects that best suit a patient's condition and pain, titrate it to adequate pain relief, continue to the medication at this level to treat the pain, and develop a plan to discontinue the medication safely.