Gaps and junctions between clinical experience and theoretical framework in the use of opioids

Excerpt

Nearly 30 years ago, the WHO published guidelines for cancer pain therapy [27]. Validation studies demonstrated a success rate exceeding 90% [8, 24]. Although physicians and nurses round the world proclaimed that cancer-induced pain can effectively be palliated, the majority of cancer patients still does not obtain sufficient pain control [4]. This has been related mainly to the myths of morphine resulting in prohibiting or underdosing of opioids or to insufficient access to opioids, since their proper use proved to be the keystone to adequate cancer pain palliation. But the approach of “give an opioid in an adequate dose and analgesia will occur” proved to be too simplistic not only with regard to the complex nature of experienced pain, but also considering the highly individualized reactions to a specific drug. With improved insights into the complicated mechanisms of opioid actions and the vulnerability of pharmacokinetics and pharmacodynamics, the focus of clinical and theoretical research drifted towards the creation of new and optimized therapeutic strategies. …