Naltrexone and problems in pain management
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7534.132 (Published 19 January 2006) Cite this as: BMJ 2006;332:132
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Editor,
The Editorial contributed by Vickers and Jolly (BMJ Vol. 332: 132-3)
is welcome, not just for highlighting the problems of pain control in
patients taking naltrexone. It should also be welcomed for opening up a
much wider debate into the problems of managing pain in opiate users
generally.
Far too little is understood about pain control in those who are
using illicit heroin and/or are on methadone or buprenorphine. There are
very large numbers of individuals on high dose opiates or opioids in the
UK and around the world, who are of course no less likely than the rest of
the population to suffer painful conditions both acute and chronic. There
is a marked dearth of published information on how to manage these
problematic situations, but a considerable likelihood of poor management
because of fear of overdosage.
Similarly, some former opiate addicts who have achieved abstinence
with the support of organisations such as Narcotics Anonymous have very
considerable fear of ever taking opiates again, even for medically
justifiable reasons, despite the likelihood of suddenly developing opiate
addiction again being very small.
Medical knowledge and understanding of pain issues in opiate addicts
is poor, and the issues complex. As usual, much more research is needed.
Competing interests:
None declared
Competing interests: No competing interests
Naltrexone in pain relief
Gordon Morse is right to bring up the subject of what to do with the
patient who needs analgesia AND is taking naltrexone!! As a community
pharmacist, I have a few patients on naltrexone, and I am aware that
should they "walk under a bus" and need emergency services, analgesia
would be the first thing that the para-medics would give after securing
the vital signs.
I encourage my patients to carry about their person the card that comes
in the pack of naltrexone that I dispense to them, that alerts anyone
attending them in an emergency, that they are taking an opiate antagonist,
and that giving any opiate agonist is not likely to do them much good!!
However, the card that I give them is likely
to get lost etc., so I have come up with an idea in conjunction with
my Rotary Club, to provide MedicAlert bracelets for anyone who is taking
naltrexone, so that the bracelet they wear can say so much when they
can't. The money involved is peanuts to a Rotary Club, but is likely to
be beyond the means of my patients.
Further in Gordon Morses' posting - about Narcotics Anonymous and taking
opiates ever again - I would aver that in extremis, this would be OK. What
are you going to do with a patient who has walked under the proverbiable
bus? I say give the treatment necessary, and deal with the consequences
afterwards!!
Competing interests:
None declared
Competing interests: No competing interests