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Proper use of analgesic drugs is critical to the management of pain. Proper diagnosis and classification of pain, its intensity measured with a validated scale, the type of pain, duration, and comorbidities are essential to select analgesic drugs. The CDC guidelines reiterate that the use of extended release opioid (especially with high dose) to start the therapy is not appropriate. In fact, the use of opioids for pain control in patients who do not respond to NSAIDs or paracetamol should be started with normal release opioids to achieve the lowest effective dose (1). The extended-release opioid remains a useful weapon to combat severe chronic pain in patients who require long periods of treatment, when we know what dose and frequency of administration is needed.
In primary care settings, the choice of a multimodal treatment, to exploit the different mechanisms of action appears a safe method to implement a drug sparing effect (2). In addition, the periodic assessment of the patient with pain to adjust treatment on the basis of clinical results is crucial to avoid drug interactions. Each drug has pros and cons, and there is no ideal drug to combat the pain. Therefore, the physician should establish a more proper care, tailoring the therapeutic strategy, always with the active participation of the patient (3). The analgesic drug is the weapon to fight the real enemy, which is still the pain. But like all weapons, the drug should be known and well used (4,5).
References
1. Geppetti P1, Benemei S. Pain treatment with opioids : achieving the minimal effective and the minimal interacting dose. Clin Drug Investig. 2009;29 Suppl 1:3-16
2. Gatti A, Sabato E., Di Paolo A.R, Mammucari M., Sabato A.F. Oxycodone/paracetamol: a low-dose synergic combination useful in different types of pain. Clinical drug investigation 2010; 30(2): 3-14
3. Mammucari M, Lazzari M, Maggiori E, Gafforio P, Tufaro G, Baffni S, Maggiori S, Sabato AF. Role of the informed consent, from mesotherapy to opioid therapy. Eur Rev Med Pharmacol Sci. 2014; 18(4):566-74
4. Maremmani I, Gerra G, Ripamonti IC, Mugelli A, Allegri M, Viganò R, Romualdi P, Pinto C, Raffaeli W, Coluzzi F, Gatti RC, Mammucari M, Fanelli G. The prevention of analgesic opioids abuse: expert opinion. Eur Rev Med Pharmacol Sci. 2015 Nov;19(21):4203-6
5. Leonardi C, Vellucci R, Mammucari M, Fanelli G. Opioid risk addiction in the management of chronic pain in primary care: the addition risk questionnaire. Eur Rev Med Pharmacol Sci. 2015; 19(24):4898-905
Analgesics or pain, who is the real enemy? Suggestions from the CDC guidelines
Proper use of analgesic drugs is critical to the management of pain. Proper diagnosis and classification of pain, its intensity measured with a validated scale, the type of pain, duration, and comorbidities are essential to select analgesic drugs. The CDC guidelines reiterate that the use of extended release opioid (especially with high dose) to start the therapy is not appropriate. In fact, the use of opioids for pain control in patients who do not respond to NSAIDs or paracetamol should be started with normal release opioids to achieve the lowest effective dose (1). The extended-release opioid remains a useful weapon to combat severe chronic pain in patients who require long periods of treatment, when we know what dose and frequency of administration is needed.
In primary care settings, the choice of a multimodal treatment, to exploit the different mechanisms of action appears a safe method to implement a drug sparing effect (2). In addition, the periodic assessment of the patient with pain to adjust treatment on the basis of clinical results is crucial to avoid drug interactions. Each drug has pros and cons, and there is no ideal drug to combat the pain. Therefore, the physician should establish a more proper care, tailoring the therapeutic strategy, always with the active participation of the patient (3). The analgesic drug is the weapon to fight the real enemy, which is still the pain. But like all weapons, the drug should be known and well used (4,5).
References
1. Geppetti P1, Benemei S. Pain treatment with opioids : achieving the minimal effective and the minimal interacting dose. Clin Drug Investig. 2009;29 Suppl 1:3-16
2. Gatti A, Sabato E., Di Paolo A.R, Mammucari M., Sabato A.F. Oxycodone/paracetamol: a low-dose synergic combination useful in different types of pain. Clinical drug investigation 2010; 30(2): 3-14
3. Mammucari M, Lazzari M, Maggiori E, Gafforio P, Tufaro G, Baffni S, Maggiori S, Sabato AF. Role of the informed consent, from mesotherapy to opioid therapy. Eur Rev Med Pharmacol Sci. 2014; 18(4):566-74
4. Maremmani I, Gerra G, Ripamonti IC, Mugelli A, Allegri M, Viganò R, Romualdi P, Pinto C, Raffaeli W, Coluzzi F, Gatti RC, Mammucari M, Fanelli G. The prevention of analgesic opioids abuse: expert opinion. Eur Rev Med Pharmacol Sci. 2015 Nov;19(21):4203-6
5. Leonardi C, Vellucci R, Mammucari M, Fanelli G. Opioid risk addiction in the management of chronic pain in primary care: the addition risk questionnaire. Eur Rev Med Pharmacol Sci. 2015; 19(24):4898-905
Competing interests: No competing interests