1 Center for Sensory-Motor Interaction, The Faculty of Medicine, Aalborg University, VBN2 The Faculty of Medicine, Aalborg University, VBN3 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN4 Klinik Medicin, The Faculty of Medicine, Aalborg University, VBN5 Medicinske Mave- og Tarmsygdomme (Gastroenterologi og Hepatologi), The Faculty of Medicine, Aalborg University, VBN6 Mech-Sense, The Faculty of Medicine, Aalborg University, VBN7 Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, VBN8 unknown
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, 2013, Vol 75, Issue 1, p. 60-78