*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 (3-4) and in alignment with treatment goals (pain intensity and functionality) as agreed with the patient (3-4)
- Patients should be made aware of the potential side effects of opioids and the potential for developing tolerance, dependence and addiction (3-4).
- 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 (5)
- 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)
- Any long term treatment with opioids should be monitored and re-evaluated regular incl. tapering down the dose or discontinuing treatment (3-4)
- Signs of opioid use disorder should be monitored and addressed (3-4)
- Patients and the general public can benefit from clear educational materials and awareness interventions to support the responsible use of opioids (6)
1. DHHS Pain Management Best Practices Inter-Agency Taskforce Report May 2019
2. O’Brien T et al. Eur J Pain 2017;21:3-192
3. Faculty of Pain Medicine, Opioids Aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware Accessed September 2019
4. Kosten TR et al, Scie Pract. Perspect 2002;1:13-20
5. Rosenblum A et al Exp. Clin. Psychopharmacol. 2008;16(5):405-416
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
Overview of medication that contains an opioid mechanism of action
Active ingredient / Technology Brand name, examples Indication range,
EU as example1
Relief of moderate to severe acute pain in adults which can be adequately managed only with opioid analgesics.
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
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