Strong opioids are used in the treatment of severe and moderate cuts or post-traumatic pain. They are also used for the onset of illness, such as myocardial ischaemia.
The potency of the opioids is classified as mild, moderate and strong. Mild opioids available in Finland include codeine, dextropropoxyphene and tramadol. Buprenorphine is a medium-strong opioid. Strong opioids include, for example, morphine, hydromorphone, oxycodone, pethidine, fentanyl and methadone.
With opioids and buprenorphine there is a roof effect, ie the effect is increased only to a certain dose. Strong opioids have a roof effect not known, so their efficacy increases as the dose increases. However, side effects and safety of use should always be weighed when considering the dose increase of potent opioids.
Various routes of administration and pathways for opioids can be selected in large quantities: oral, intramuscular or intramuscular, epidural, cerebral spinal fluid or patches through the skin. The most suitable route of administration is evaluated according to both the patient’s location and the pain strength. In acute postoperative pain, the greatest patient satisfaction has been through a thin hose directly around the nerve fibers to treat the epidural pain management. This, however, is limited to hospitalization in the treatment of acute illness or postoperative pain. In the treatment of cancer, epidural drug administration is also used in home care with a pain pump.
In the outpatient care acoustic pain is especially well suited for opioid opioids, but oral administration of stronger opioids, for example postoperative pain, is good experience.
The most common opioid used in the world is codeine.
In Finland, codeine is only available in combination formulations, either in combination with paracetamol or ibuprofen. Codein is well absorbed orally and rarely causes addiction. Do not exceed the 240 mg daily dose due to the roof effect. Codeine is a so-called. a prodrug that is converted to an active substance (morphine) in the liver due to the CYP2D6 enzyme. With about 7% of Finns, this enzyme activity is so scarce that codeine is an ineffective drug for them.
The use of dextropropoxyphene has decreased all the time. The drug has a relatively narrow safe use range and can even be used in conjunction with low overdoses or low amounts of alcohol to result in dangerous respiratory paralysis. The maximum daily dose is 450mg.
Tramadol affects both opioid receptors as well as stimulating serotonin release and reducing serotonin and norepinephrine reuptake. Due to its two mechanisms of action, it is also useful in the treatment of nerve damage. Tramadol is available in tablets, drops, suppositories and injections. The maximum daily dose is 400 mg.
It provides an average of about 8 hours of pain relief and is used to treat postoperative and cancer pain in moderate to severe pain in children and adults. Side effects are similar to strong opioids. In the long-term use of the patch is likely to overcome the use of the tablet.
The administration of strong opioids intravenously produces rapid pain relief. In the treatment of acute, severe pain, the use of strong opioids either intravenously or intramuscularly is an ordinary and effective way of treating pain. After injury or surgery, strong opioids are also suitable for oral administration, allowing the drug to be used also in home care. For example, in day surgery, a few early opioids given by the patient to a postoperative day can significantly improve pain relief than mild opioids or anti-inflammatory drugs alone. Oral forms of strong opioids in Finland are available for morphine, oxycodone, hydromorphone and methadone.
Combining NSAIDs with strong analgesics generally improves the pain-relief capacity. Thus, the opioid should be combined with anti-inflammatory drugs or paracetamol, especially in the treatment of tissue damage and acute pain or post-traumatic pain.
In long-lasting pain, the goals of opioid therapy are the same as for other long-lasting pain medications: 30 to 50% relief for pain, easier movement, improved stress relief, improved quality of life and a better night’s sleep.
Long-acting products are used to treat long-term, non-cancer-related pain. Alternatives include prolonged release tablets (morphine, oxycodone, hydromorphone) or patch (fentanyl). Short-acting preparations should be avoided. Methadone is more rapid in tablet form but has a very long half-life, and is also suitable for long-term use.
As a precondition for opioid therapy in non-cancerous cancer, despite other treatments, there is a severe continuous injury to tissue injury or nerve injury which can not be reasonably practiced.
There must be no patient
An untreated mental disorder, he / she must be motivated and committed to treatment and given care instructions, and he / she should not have a misuse of drugs or substance abuse. Treatment with strong opioids requires regular treatment. Constipation is the most commonly reported side effect, to prevent constipation being started at the beginning of the opioids. The principle of opioid therapy for all types of pain is to seek an effective dose or titrate to a medication level with related side effects acceptable to the benefit gained. If the pain of the patient is round the clock, opioid therapy should be regularly administered, if necessary, not taken.
Regularly used also for the severity of side effects develops more easily than when needed. The aim of the opioid drug is to improve the quality of life. The response should be at least significant (30 – 50% relieving pain and thereby improving physical, psychological and social functions). Long-term opioid medication should also be used to relieve or become susceptible to problems with tolerability. Likewise, medication should be discontinued if its need for eg healing or cure after surgery, such as surgery, is complete.
When switching to opioid therapy, other pain relief treatments and medications should be continued. This is often the case with, for example, anti-inflammatory drugs, depression medicines, other drugs used to treat nerve pain, TNS and psychological pain management methods. Avoiding sharing of opioids and sedatives will be avoided to avoid harmful interactions and mental functions (memory, concentration, reasoning).