There is a great deal of interest in the effective use of opioids for cancer pain due to concerns from both clinicians and patients about addiction. When used correctly, opioids are capable of relieving pain in more than 90 percent of cancer patients. In reality, patients world-wide continue to endure pain usually due to irrational fears about using them. Fear of addiction is fed by outdated knowledge about opioids and the unintended effects of the war on drugs. However, new research shows that using opioids appropriately for pain management is effective, safe, and has an extremely low potential to produce addiction. This book provides evidence (on which guidelines can be based) from an international group of editors and contributors on opioids in cancer pain management, aimed at palliative care doctors, pharmacists, pain specialists, and oncologists. It includes information on opioid pharmacokinetics as a basis for understanding opioid analgesia, dosing schedule, polymorphisms of analgesic receptors in relationship to tolerance, and intrinsic efficacy. The main body of the book covers individual opioids. Topics within each chapter include structure, pharmacokinetics, pharmacodynamics, routes of administration, toxicity, drug interactions and influences of dosing and kinetics related to organ function. A chapter is dedicated to the WHO analgesic guidelines and opioid choices.
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Opioids have become invaluable in modern medicine but it is essential that they are prescribed with an understanding of the complex pharmacology behind their effectiveness; without this, they will frequently fail to achieve their enormous potential of pain relief, minimal side effects, and improved function. In addition, opioids come with problems, including side effects such as constipation, respiratory depression, and sedation, as well as the potential for substance abuse. Clinicians handling the complex pain problems of cancer patients must incorporate the insight of basic scientists and pharmacologists, and this new edition of this comprehensive text brings together a wealth of experience from those involved in all aspects of opioids, with a view to improving both clinician understanding and patient care. The text includes comprehensive coverage of the principles of opioid pharmacodynamics, pharmacokinetics, and pharmacogenetics. A chapter is dedicated to each of the main opioids, with topics such as structure, routes of administration, toxicity, drug interactions, and effects on organ function included within each one. The book concludes with several chapters dedicated to discussion of the major issues relevant to opioid use, including substance abuse, dosing strategies for acute and chronic pain, patient controlled analgesia, equianalgesia, spinal opioids, pain that doesn't respond to opioids, and the terminal phase. This text is the most complete and extensive work available on the use of opioids for cancer pain, and is an important reference for those clinicians treating individuals with cancer.
Each chapter is well referenced, providing an excellent critical review of the literature in this field. (American Journal of Epidemiology )
This is the best current textbook on the clinical use of opioids in cancer pain (and in chronic benign pain). (BMA Medical Book Competition 2010 )
...well set out with the good use of headings... well-referenced... the editors are to be congratualted for putting together what remains the premier reference on opioids in cancer pain (Roger Woodruff )
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