THE PHARMACOLOGICAL RELIEF OF PAIN - CONTEMPORARY-ISSUES

Objective: To provide a general description of the pharmacological principles of pain management particularly the management of severe pain with opioid analgetic agents. Data sources: Literature updating previous reviews by the authors in this Journal and the Proceedings of the Vlth World Congress on Pain, Adelaide, 1-6 April 1990. Study selection: Studies were selected under the subheadings: opioid receptors; endogenous opioids; development of new agents; recognition of the need to improve analgesia; pharmacokinetics and pharmacodynamics of opioids; and novel drug delivery methods. Data extraction: The extracted information was more descriptive than quantitative. Data synthesis: The pharmacological relief of pain involves treatment of patients with drugs characterised by extremely large inter-patient variability in pharmacokinetics and pharmacodynamics by way of an extremely complex interaction with endogenous control mechanisms. lt is not surprising that management of pain in many patients is less than adequate. Conclusions: Although much vigorous interdisciplinary research is being undertaken to develop a scientific basis for understanding pain and analgesia, improvements in the clinical management of pain can only occur if practitioners recognise the need for individualised methods of pain relief and treat their patients accordingly.