[How to advance in treating pain with opioids: less myths--less pain].

Abstract

Much progress has taken place in knowledge of actions and use of opioids in pain in the last quarter century. There would be much less unnecessary pain and suffering if this knowledge would be applied properly in clinical practice. Why is it not? The major reasons appear to be ignorance, false prejudices (myths) and exaggerated limitations in availability of opioids for medical treatment of pain. Even the strongest opioid analgesics do not need to relieve pain in everybody. Their effect should be monitored and if inadequate, proper measures should be taken (e.g. adjusting a dose or changing an opioid). Weak opioids (codeine, tramadol) alone are mostly not stronger then non-opioid analgesics. However, combinations of opioid analgesics with paracetamol often show synergistic analgesic effect (without increased toxicity). Opioids actually represent very safe analgesics. Exaggerated opiophobia is a major myth causing much unnecessary pain and suffering in patients. Undue fear of drug abuse and/or political considerations have resulted in laws and regulations, that make it unnecessarily difficult to obtain opioids for medical use. An example of this might be a recent re-scheduling of buprenorphine in the Czech Republic and Slovakia among drugs with a very high abuse potential (e.g. morphine, fentanyl, amphetamine).