Opioids In Practice

Question 1

What are the components of chronic pain?

Answer 1

• physical
• psychological
• environmental
• sensitisation (e.g. allodynia, hyperalgesia)

Question 2

Mechanism of action of opioids?

Answer 2

• opioid receptors are distributed throughout the CNS, and to a lesser extent the PNS
• act pre-synaptically to inhibit neurotransmitter release

Question 3

GI side effects of opioids?

Answer 3

• constipation
• nausea

Question 4

Respiratory side effects of opioids?

Answer 4

Sleep-disordered breathing (with chronic use).

Question 5

Neurological side effects of opioids?

Answer 5

• dizziness
• sedation
• respiratory depression

Question 6

Musculoskeletal side effects of opioids?

Answer 6

Increased risk of fractures (due to dizziness / sedation).

Question 7

Endocrine side effects of opioids?

Answer 7

• hypogonadism & sexual dysfunction
• osteoporosis
• oligomenorrhoea
• galactorrhoea

Question 8

Immune side effects of opioids?

Answer 8

Reduced immunity.

Question 9

Non-pharmacological management of chronic pain?

Answer 9

Physical: weight loss, smoking cessation, exercise, physiotherapy, yoga.

Psychological: counselling, CBT, music, meditation, relaxation.

Complementary therapy: massage, reflexology, acupuncture.

Question 10

What are some signs of opioid abuse & dependency?

Answer 10

• use of opioids other than for pain
• impaired control of opioid use
• continued use despite harm
• escalation of use
• selling / altering prescriptions
• stealing medications
• requests for early refills / losing prescriptions
• reluctance to try non-pharmacological interventions