Opioid and adjuvant analgesics: compared and contrasted

Opioid and adjuvant analgesics: compared and contrasted. [Am J Hosp Palliat Care. 2011] – PubMed – NCBI

Pain patients are usually prescribed additional medications to reduce their need for opiates, despite the known toxicity of these adjuvant analgesics.

An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids.

The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects.

A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure

In other words, the adjuvant analgesics being used are toxic, while opiates aren’t, but pain patients are always forced to use the AA’s.

Most AAs have a ceiling effect for their analgesic actions, but often with continued dose-related toxicities and side effects (with the exception of glucocorticoids).

The therapeutic window of opioids is wide, with no ceiling effect. Most AAs (except corticosteroids) have a narrow therapeutic window.

Dose flexibility is much less with AAs than opioids. Unlike opioids, the analgesic response is usually observed within hours to days of attaining an adequate dose with most AAs (1-2 days).

Rotation among opioids is a useful therapeutic strategy to improve analgesic response or minimize toxicity.

Opioids are among the most effective and potent analgesics currently available. Their utility in the management of pain associated with cancer, acute injury, or surgery is well recognized. However, extending the application of opioids to the management of chronic non-cancer pain has met with considerable resistance.

Thus, forcing patients to take these toxic AA’s, rather than the far less damaging opoids, seems almost like malpractice.  These medications are known to be toxic, yet they are pushed on patients even while a more effective and less damaging alternative is available.

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