General considerations for the management of pain with any medication that contains an opioid mechanism of action
The following general aspects should be considered
- An individualized, patient-centered approach for the diagnosis and treatment of pain is essential to establish a therapeutic alliance between patient and clinician
- Consider patient variables that may affect opioid dose for each patient prior to opioid use (1)
- In patients with acute pain e.g., post-surgery pain, the use of medication should be for the shortest necessary time (1)
All patients should be carefully selected, abuse risk factors evaluated and regular monitoring and follow-up implemented to ensure that opioids are used appropriately (2-3) and in alignment with treatment goals (pain intensity and functionality) as agreed with the patient (2-3) - Patients should be made aware of the potential side effects of opioids and the potential for developing tolerance, dependence and addiction (2-3)
- It is important to optimally use multimodal, non-opioid approaches in acute and chronic pain before escalating to opioids or in conjunction with opioid therapy (1)
- Addiction is possible even when opioids are taken as directed. The exact prevalence of abuse in patients treated with opioids for chronic pain is difficult to determine (4)
- Regular clinical reviews are required for long-term opioid treatment to assess pain control, impact on lifestyle, physical and psychological well-being, side effects and continued need for treatment (2,5)
- Any long-term treatment with opioids should be monitored and re-evaluated regularly incl. tapering down the dose or discontinuing treatment (2-3)
- Signs of opioid use disorder should be monitored and addressed (2-3)
- Patients and the general public can benefit from clear educational materials and awareness interventions to support the responsible use of opioids (6)
M-N/A-HQ-02-20-0012
1. DHHS Pain Management Best Practices Inter-Agency Taskforce Report May 2019
2. Faculty of Pain Medicine, Opioids Aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware Accessed September 2019
3. Kosten TR et al, Scie Pract. Perspect 2002;1:13-20
4. Rosenblum A et al Exp. Clin. Psychopharmacol. 2008;16(5):405-416
5. O’Brien T et al. Eur J Pain 2017;21:3-192
6. OECD Health Policy. Addressing Problematic opioid use in OECD Countries May 2019
http://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-countries-a18286f0-en.htm
For Grünenthal’s charter on the responsible medical use of opioids, please open the following document.
Overview of medication that contains an opioid mechanism of action
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Product list
Active ingredient / Technology Brand name, examples Indication range,
EU as example1Tapentadol Palexia®
Film-coated tablet:
Relief of moderate to severe acute pain in adults which can be adequately managed only with opioid analgesics.
Oral solution:
Relief of moderate to severe acute pain in children2 from 2 years of age and in adults, which can be adequately managed only with opioid analgesics
Prolonged-release tablet:
Management of severe chronic pain in adults which can be adequately managed only with opioid analgesics.Tramadol Tramal® Treatment of moderate to severe pain. Fixed-dose combination of Tramadol and Paracetamol Zaldiar® Symptomatic treatment of moderate to severe pain; use should be restricted to patients whose moderate to severe pain is considered to require a combination of tramadol and paracetamol. Buprenorphine Transtec® Treatment of moderate to severe cancer pain and severe pain which does not respond to non-opioid analgesics. Transtec is not suitable for the treatment of acute pain.
2 In children restricted to hospital use where appropriate equipment to enable respiratory support is available and for a maximum treatment duration of 3 days