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Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Review Article

Opioid Analgesics Adverse Effects: The Other Side of the Coin

Author(s): Sebastiano Mercadante*

Volume 25, Issue 30, 2019

Page: [3197 - 3202] Pages: 6

DOI: 10.2174/1381612825666190717152226

Price: $65

Abstract

Background: Opioids are the cornerstone of the management of cancer pain. However, the development of adverse effects may compromise the opioid response. They include nausea and vomiting, constipation, drowsiness, sleep disorders, cognitive dysfunction, myoclonus, pruritus, dysuria, dependence and the development of aberrant behaviors, respiratory depression, and some endocrine responses.

Methods: The goal of this paper is to identify the most common opioid-related adverse effects, their pathophysiology, and proposing the possible treatments. This narrative review will describe how these adverse effects may develop and how to prevent or to treat.

Conclusion: Intensity of adverse effects tend to decrease with continuous use. However, they may be persistent and may require symptomatic treatment or more complex treatment including alternative strategies for pain management.

Keywords: Cancer pain, opioids, adverse effects, cognitive dysfunction, pruritus, dysuria.

[1]
McNicol E, Horowicz-Mehler N, Fisk RA, et al. Americal Pain Society. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain 2003; 4(5): 231-56.
[http://dx.doi.org/10.1016/S1526-5900(03)00556-X] [PMID: 14622694]
[2]
Cepeda MS, Farrar JT, Baumgarten M, Boston R, Carr DB, Strom BL. Side effects of opioids during short-term administration: effect of age, gender, and race. Clin Pharmacol Ther 2003; 74(2): 102-12.
[http://dx.doi.org/10.1016/S0009-9236(03)00152-8] [PMID: 12891220]
[3]
Smith HS, Laufer A. Opioid induced nausea and vomiting. Eur J Pharmacol 2014; 722: 67-78.
[http://dx.doi.org/10.1016/j.ejphar.2013.09.074] [PMID: 24157979]
[4]
Mercadante S. Diarrhea, Malabsorption, Constipation. In: Principles and practice of palliative care and supportive oncology. 4th edition. A Berger, J.J. Shuster Von Roenn. Lippincott, Philadelphia 2013; pp. 175-92.
[5]
Pappagallo M. Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg 2001; 182(5A)(Suppl.): 11S-8S.
[http://dx.doi.org/10.1016/S0002-9610(01)00782-6] [PMID: 11755892]
[6]
Allan L, Hays H, Jensen NH, et al. Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. BMJ 2001; 322(7295): 1154-8.
[http://dx.doi.org/10.1136/bmj.322.7295.1154] [PMID: 11348910]
[7]
Cherny N, Ripamonti C, Pereira J, et al. Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 2001; 19(9): 2542-54.
[http://dx.doi.org/10.1200/JCO.2001.19.9.2542] [PMID: 11331334]
[8]
Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manage 2013; 45(1): 2-13.
[http://dx.doi.org/10.1016/j.jpainsymman.2012.02.008] [PMID: 22889861]
[9]
Müller-Lissner S, Bassotti G, Coffin B, et al. Opioid-induced constipation and bowel dysfunction: a clinical guideline. Pain Med 2017; 18(10): 1837-63.
[PMID: 28034973]
[10]
Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 2008; 358(22): 2332-43.
[http://dx.doi.org/10.1056/NEJMoa0707377] [PMID: 18509120]
[11]
Nalamachu S, Gudin J, Datto C, Coyne K, Poon JL, Hu Y. Efficacy and safety of naloxegol for opioid-induced constipation assessed by specific opioid medication, opioid dose, and duration of opioid use. J Opioid Manag 2018; 14(3): 211-21.
[http://dx.doi.org/10.5055/jom.2018.0451] [PMID: 30044486]
[12]
Lawlor PG. The panorama of opioid-related cognitive dysfunction in patients with cancer: a critical literature appraisal. Cancer 2002; 94(6): 1836-53.
[http://dx.doi.org/10.1002/cncr.10389] [PMID: 11920548]
[13]
Bruera E, Miller MJ, Macmillan K, Kuehn N. Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain. Pain 1992; 48(2): 163-6.
[http://dx.doi.org/10.1016/0304-3959(92)90053-E] [PMID: 1589233]
[14]
Reissig JE, Rybarczyk AM. Pharmacologic treatment of opioid-induced sedation in chronic pain. Ann Pharmacother 2005; 39(4): 727-31.
[http://dx.doi.org/10.1345/aph.1E309] [PMID: 15755795]
[15]
O’Mahony S, Coyle N, Payne R. Current management of opioid-related side effects. Oncology 2001; 15(1): 61-73.
[PMID: 11271983]
[16]
Mercadante S. Opioid-related adverse effects.H Smith, JG Pilitis. AME Publishibng group 2014; pp. 185-97.
[17]
Mercadante S. Pathophysiology and treatment of opioid-related myoclonus in cancer patients. Pain 1998; 74(1): 5-9.
[http://dx.doi.org/10.1016/S0304-3959(97)00090-0] [PMID: 9514554]
[18]
Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs 2007; 67(16): 2323-33.
[http://dx.doi.org/10.2165/00003495-200767160-00003] [PMID: 17983254]
[19]
Davies A, Bagg J, Laverty D, et al. Salivary gland dysfunction (‘dry mouth’) in patients with cancer: a consensus statement. Eur J Cancer Care 2010; 19: 172-7.
[20]
Mercadante S, Calderone L, Villari P, et al. The use of pilocarpine in opioid-induced xerostomia. Palliat Med 2000; 14(6): 529-31.
[http://dx.doi.org/10.1191/026921600701536273] [PMID: 11219883]
[21]
Glare P, Walsh D, Sheehan D. The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain. Am J Hosp Palliat Care 2006; 23(3): 229-35.
[http://dx.doi.org/10.1177/1049909106289068] [PMID: 17060284]
[22]
Mercadante S, Ferrera P, Casuccio A. Prevalence of opioid-related dysuria in patients with advanced cancer having pain. Am J Hosp Palliat Care 2011; 28(1): 27-30.
[http://dx.doi.org/10.1177/1049909110374454] [PMID: 20713423]
[23]
Borgbjerg FM, Nielsen K, Franks J. Experimental pain stimulates respiration and attenuates morphine-induced respiratory depression: a controlled study in human volunteers. Pain 1996; 64(1): 123-8.
[http://dx.doi.org/10.1016/0304-3959(95)00088-7] [PMID: 8867254]
[24]
Francisco N. Control of breathing: how to better understand the respiratory effects of opioids. Eur J Pain 2008; 7(1): 61-5.
[25]
Højsted J, Sjøgren P. Addiction to opioids in chronic pain patients: a literature review. Eur J Pain 2007; 11(5): 490-518.
[http://dx.doi.org/10.1016/j.ejpain.2006.08.004] [PMID: 17070082]
[26]
Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007; 129(3): 235-55.
[http://dx.doi.org/10.1016/j.pain.2007.03.028] [PMID: 17482363]
[27]
Ballantyne JC. Opioid misuse in oncology pain patients. Curr Pain Headache Rep 2007; 11(4): 276-82.
[http://dx.doi.org/10.1007/s11916-007-0204-6] [PMID: 17686391]
[28]
Hutchinson MR, Bland ST, Johnson KW, Rice KC, Maier SF, Watkins LR. Opioid-induced glial activation: mechanisms of activation and implications for opioid analgesia, dependence, and reward. ScientificWorldJournal 2007; 7(S2): 98-111.
[http://dx.doi.org/10.1100/tsw.2007.230] [PMID: 17982582]
[29]
Kwon JH, Tanco K, Park JC, et al. Frequency, predictors, and medical record documentation of chemical coping among advanced cancer patients. Oncologist 2015; 20(6): 692-7.
[http://dx.doi.org/10.1634/theoncologist.2015-0012] [PMID: 25933929]
[30]
Arthur J, Edwards T, Reddy S, et al. Outcomes of a specialized interdisciplinary approach for patients with cancer with aberrant opioid-related behavior. Oncologist 2018; 23(2): 263-70.
[http://dx.doi.org/10.1634/theoncologist.2017-0248] [PMID: 29021378]
[31]
Vallejo R. de leon Casasola O, Benyamin R. Opioid therapy and immunosuppression. Am J Ther 2004; 11: 354-65.
[http://dx.doi.org/10.1097/01.mjt.0000132250.95650.85] [PMID: 15356431]
[32]
Rajagopal A, Vassilopoulou-Sellin R, Palmer JL, Kaur G, Bruera E. Symptomatic hypogonadism in male survivors of cancer with chronic exposure to opioids. Cancer 2004; 100(4): 851-8.
[http://dx.doi.org/10.1002/cncr.20028] [PMID: 14770444]

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