Opioids in pain

Over the next twelve months, the Virtual Pain Centre plans to run a series of articles addressing many of the issues that confront practitioners when contemplating the prescription of opioids for the management of pain.

Morphine has been available for centuries and is widely used and accepted as an effective analgesic. Apart from analgesia, morphine has many other effects, some useful, some not. We hope that with this upcoming series of articles we can help practitioners weigh up the pros and cons of prescribing opioids and balance the benefits with the side-effects.Questions we will seek to address include:

• What dose of morphine should I start a patient on who has a recently-diagnosed carcinoma of the pancreas or metastatic prostate cancer?
• How quickly should I escalate the dose?
• What side-effects might occur when using morphine for this type of patient?
• Are opioids valuable in the treatment of back pain?
• What is their role?
• How do I assess their value in chronic non-cancer pain?
• What is opioid-induced hyperalgesia?
• Is there a ceiling effect for morphine?
• What are the current rules and regulations with regards to prescribing morphine in Australia in 2006?
• What are the clinical differences between the various types of opioid available?
• What is the difference between tolerance, dependency and addiction? How can I tell?
• How long can I prescribe morphine for?
• Should morphine ever be used as the only treatment option?

Where possible, we will try and use an evidence-based approach to provide guidance to answer some of these questions. We will welcome input from members of the public and healthcare professionals, and provide comment from our editorial advisory board.Dr Roger Goucke MBChB DTM&H MRCGP FANZCA FFPMANZCA FAChPM, Medical Director of Virtual Pain Centre and Head of Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Western Australia.