1 Pharmacotherapy, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, Københavns Universitet2 Institut for Klinisk Medicin - Medicinsk Gastroenterologisk Afdeling, Medicinsk Center, Aalborg Sygehus3 Department of Complex Decision and Health Policy, Université Claude Bernard Lyon4 Institut for Klinisk Medicin - Center for visceral biomekanik og smerte, AAL5 Department of Palliative Medicine, Royal Marsden Hospital, London6 Institut for Medicin og Sundhedsteknologi7 Department of Anesthesiology, Leiden University Medical Center, Leiden8 Pharmacotherapy, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, Københavns Universitet
pharmacological, experimental, clinical and economical perspectives
Clinical studies comparing the response and side effects of various opioids have not been able to show robust differences between drugs. Hence, recommendations of the regulatory authorities have been driven by costs with a general tendency in many countries to restrict physician's use of opioids to morphine. Although this approach is recognized as cost-effective in most cases there is solid evidence that, on an individual patient basis, opioids are not all equal. Therefore it is important to have an armamentarium of strong analgesics in clinical practice to ensure a personalized approach in patients who do not respond to standard treatment. In this review we highlight differences between opioids in human studies from a pharmacological, experimental, clinical and health economics point of view. We provide evidence that individuals respond differently to opioids, and that general differences between classes of opioids exist. We recommend that this recognition is used to individualize treatment in difficult cases allowing physicians to have a wide range of treatment options. In the end this will reduce pain and side effects, leading to improved quality of life for the patient and reduce the exploding pain related costs.
British Journal of Clinical Pharmacology. Supplement, 2013, Vol 75, Issue 1, p. 60-78