Opioids in the treatment of non-specific acute and chronic pain


  • D V Dmytriiev National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • O A Zaletska National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • D I Bortnik National Pirogov Memorial Medical University, Vinnytsia, Ukraine




opioids, nalbuphine, chronic pain, acute pain, analgesia


After reading this article, the reader will be familiar with the general classes of opioid agonists and partial agonists, the basics of the pharmacokinetics and pharmacodynamics of opioids, the risks of opioid therapy and the requirements for the safe and effective use of opioids in acute and chronic pain. The use of opioids during surgical procedures or anesthesia is not discussed. Also, there is no discussion about various available opioid antagonists that are used to treat overdose and the various disorders associated with their use (including naloxone and naltrexone). Opioids are available, the most powerful and effective analgesics, and have become acceptable drugs for the treatment of acute and cancerous pain. However, there is concern about their use in case of chronic pain, if there is no cancer, because they are long-range ineffective but best suited for stopping this pain. Opioid prescription must be monitored for better use. Chronic pain creates discomfort for these patients, reducing their productivity and efficiency, which, in turn, can lead to economic problems in the country. The choice of Nalbuphine is due to the following reasons: the opioid, which is comparable to morphine by its analgesic potential, but has a better safety profile for nausea, vomiting and respiratory depression; not subject to strict quantitative accounting (extract on prescription form 1); the choice of opioid analgesics is significantly limited in Ukraine.


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Gutstein H, Akil H. Opioid analgesics. In: Hardman JG, Limbird LE, Gilman AG, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York: McGrawHill; 2001:569–619.

Yaksh T, Wallace M. Opioids, analgesia and pain management. In: Brunton L, Knollmann B, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill; 2017:255–86.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recommendations and Reports [Internet]. Centers for Disease Control MMWR Office; 2016 Mar 15;65(1):1–49. Available from: https://doi.org/10.15585/mmwr.rr6501e1er

Errata: Vol. 65, No. RR-1. MMWR Morbidity and Mortality Weekly Report [Internet]. Centers for Disease Control MMWR Office; 2016 Mar 25;65(11):295. Available from: https://doi.org/10.15585/mmwr.mm6511a6

Manchikanti L, Kaye AM, Knezevic NN, et al. Responsible, safe, and effective prescription of opioids for chronic noncancer pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2017;20(2S):S3–S92.

Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I – evidence assessment. Pain Physician. 2012;15(3 suppl):S1–S65.

Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2 – guidance. Pain Physician. 2012;15(3 suppl):S67–S116.

FDA. Draft Revisons to the FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain U.S. Food and Drug Administration. 2017.

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morbidity and Mortality Weekly Report [Internet]. Centers for Disease Control MMWR Office; 2016 Dec 30;65(5051):1445–52. Available from: https://doi.org/10.15585/mmwr.mm655051e1

Erratum: Vol. 65, Nos. 50 & 51. MMWR Morbidity and Mortality Weekly Report [Internet]. Centers for Disease Control MMWR Office; 2017 Jan 13;66(01):35. Available from: https://doi.org/10.15585/mmwr.mm6601a10

Hermann R, Derendorf H, von Richter O, Rostami-Hodjegan A. Core Entrustable Professional Activities in Clinical Pharmacology: Pearls for Clinical Practice. The Journal of Clinical Pharmacology [Internet]. Wiley; 2018 Mar 7;58(6):704–16. Available from: https://doi.org/10.1002/jcph.1088

Somogyi AA, Barratt DT, Coller JK. Pharmacogenetics of Opioids. Clinical Pharmacology & Therapeutics [Internet]. Springer Nature; 2007 Mar;81(3):429–44. Available from: https://doi.org/10.1038/sj.clpt.6100095

Sloan, MD PA, Barkin, PharmD, MBA RL. Oxymorphone and oxymorphone extended release: A pharmacotherapeutic review. Journal of Opioid Management [Internet]. Weston Medical Publishing; 2018 Jan 30;4(3):131. Available from: https://doi.org/10.5055/jom.2008.0018

Cajanus K, Neuvonen M, Koskela O, Kaunisto MA, Neuvonen PJ, Niemi M, et al. Analgesic Plasma Concentrations of Oxycodone After Surgery for Breast Cancer—Which Factors Matter? Clinical Pharmacology & Therapeutics [Internet]. Wiley; 2017 Aug 24;103(4):653–62. Available from: https://doi.org/10.1002/cpt.771

Nafziger AN, Bertino JS. Utility and Application of Urine Drug Testing in Chronic Pain Management With Opioids. The Clinical Journal of Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Jan;25(1):73–9. Available from: https://doi.org/10.1097/ajp.0b013e31817e13cc

Lam LH, Pirrello RD, Ma JD. A Case-Based Approach to Integrating Opioid Pharmacokinetic and Pharmacodynamic Concepts in Cancer Pain Management. The Journal of Clinical Pharmacology [Internet]. Wiley; 2015 Dec 30;56(7):785–93. Available from: https://doi.org/10.1002/jcph.676

Herzig S, Mosher H, Calcaterra S, Jena A, Nuckols T. Improving the Safety of Opioid Use for Acute Noncancer Pain in Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine. Journal of Hospital Medicine [Internet]. Frontline Medical Communications, Inc.; 2018 Apr 18;13(4):263–71. Available from: https://doi.org/10.12788/jhm.2980

Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone). Pain Practice [Internet]. Wiley; 2008 Jul;8(4):287–313. Available from: https://doi.org/10.1111/j.1533-2500.2008.00204.x

Wyatt R. Pain and ethnicity. AMA J Ethics. 2013;15(5):449–54.

FDA. Extended-Release (ER) and Long-Acting (LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS). White Oak, MD: US Food and Drug Administration; 2015.

Mayyas F, Fayers P, Kaasa S, Dale O. A Systematic Review of Oxymorphone in the Management of Chronic Pain. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2010 Feb;39(2):296–308. Available from: https://doi.org/10.1016/j.jpainsymman.2009.07.010

NUCYNTAR (tapentadol) package insert. Canton, MA: Collegium Pharmaceutical, Inc. 2016:1–11.

Pain Treatment with Opioid Medications: Patient Agreement. Sample patient treatment agreement for opioid use. https://www.drugabuse.gov/sites/default/files/files/SamplePatientAgree mentForms.pdf. Accessed April 13, 2018.

Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, et al. Guideline for opioid therapy and chronic noncancer pain. Canadian Medical Association Journal [Internet]. Joule Inc.; 2017 May 7;189(18):E659–E666. Available from: https://doi.org/10.1503/cmaj.170363

Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. Longo DL, editor. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2016 Mar 31;374(13):1253–63. Available from: https://doi.org/10.1056/nejmra1507771

Williams JT, Christie MJ, Manzoni O. Cellular and Synaptic Adaptations Mediating Opioid Dependence. Physiological Reviews [Internet]. American Physiological Society; 2001 Jan;81(1):299–343. Available from: https://doi.org/10.1152/physrev.2001.81.1.299

Barkin, MBA, PharmD, FCP, DAAPM, DACFE, DACPS RL, Barkin, BA, MA, MEd, PsyD SJ. Treating postoperative pain in the patient who is in recovery or remission from opioid abuse: Focus on Tapentadol. Journal of Opioid Management [Internet]. Weston Medical Publishing; 2017 May 1;13(3):133. Available from: https://doi.org/10.5055/jom.2017.0378

Gammaitoni AR, Fine P, Alvarez N, McPherson ML, Bergmark S. Clinical Application of Opioid Equianalgesic Data. The Clinical Journal of Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Sep;19(5):286–97. Available from: https://doi.org/10.1097/00002508-200309000-00002

Lugo R, Satterfield K, Kern S. Pharmacokinetics of Methadone. Journal Of Pain & Palliative Care Pharmacotherapy [Internet]. The Haworth Press; 2005 Jan 6;19(4):13–24. Available from: https://doi.org/10.1300/j354v19n04_05

Fine PG, Portenoy RK. Establishing “Best Practices” for Opioid Rotation: Conclusions of an Expert Panel. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2009 Sep;38(3):418–25. Available from: https://doi.org/10.1016/j.jpainsymman.2009.06.002

Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain 2009;10(2):113-30. The Spine Journal [Internet]. Elsevier BV; 2010 Apr;10(4):355–6. Available from: https://doi.org/10.1016/j.spinee.2010.01.027

Gourlay DL, Heit HA. Pain and Addiction: Managing Risk Through Comprehensive Care. Journal of Addictive Diseases [Internet]. Informa UK Limited; 2008 Jun 12;27(3):23–30. Available from: https://doi.org/10.1080/10550880802122570

Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in Equianalgesic Dosing. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2001 May;21(5):397–406. Available from: https://doi.org/10.1016/s0885-3924(01)00271-8

Knotkova H, Fine PG, Portenoy RK. Opioid Rotation: The Science and the Limitations of the Equianalgesic Dose Table. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2009 Sep;38(3):426–39. Available from: https://doi.org/10.1016/j.jpainsymman.2009.06.001

Shaheen PE, Walsh D, Lasheen W, Davis MP, Lagman RL. Opioid Equianalgesic Tables: Are They All Equally Dangerous? Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2009 Sep;38(3):409–17. Available from: https://doi.org/10.1016/j.jpainsymman.2009.06.004

Vallejo R, Barkin RL, Wang VC. Pharmacology of opioids in the treatment of chronic pain syndromes. Pain Physician. 2011 Jul-Aug;14(4):E343-60.

Levy MH. Pain management in advanced cancer. InSeminars in oncology 1985 Dec (Vol. 12, No. 4, pp. 394-410).

Duttaroy A, Yoburn BC. The Effect of Intrinsic Efficacy on Opioid Tolerance. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1995 May;82(5):1226–36. Available from: https://doi.org/10.1097/00000542-199505000-00018

Peppin J. Toward a systematic approach to opioid rotation. Journal of Pain Research [Internet]. Dove Medical Press Ltd.; 2014 Oct;589. Available from: https://doi.org/10.2147/jpr.s55782

FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-Threatening Opioid Overdose in the Community Settings. Joint Meeting of the Anesthetic and Analgesic Drug Products Advisory Committee and the Drug Safety and Risk Management Advisory Committee on October 5, 2016; Advisory Committee Briefing Materials. https://www.fda.gov/downloads/Advisory/Committees/CommitteesMeetingMaterials/Drugs/AnestheticAndAnalgesicDrugProductsAdvisoryCommittee/UCM522688.pdf. Accessed April 17, 2018.

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA [Internet]. American Medical Association (AMA); 2018 May 1;319(17):1819. Available from: https://doi.org/10.1001/jama.2018.2844

Prekupec MP, Mansky PA, Baumann MH. Misuse of Novel Synthetic Opioids. Journal of Addiction Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2017;11(4):256–65. Available from: https://doi.org/10.1097/adm.0000000000000324

Schumann H, Erickson T, Thompson TM, Zautcke JL, Denton JS. Fentanyl epidemic in Chicago, Illinois and surrounding Cook County. Clinical Toxicology [Internet]. Informa UK Limited; 2008 Jan;46(6):501–6. Available from: https://doi.org/10.1080/15563650701877374

FDA. Disposal of Unused Medicines: What You Should Know. 2018. https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. Accessed April 14, 2018.

Current Opioid Misuse Measure (COMM)TM. 2008. https://www.opioidprescribing.com/documents/09-comm-inflexxion.pdf . Accessed April 1, 2018.

Pain Assessment and Documentation Tool. 2003. http://www.practiceadvisor.org/docs/default-source/documents/pain_ assessment_and_documentation_tool. Accessed April 1, 2018.

Adams LL, Gatchel RJ, Robinson RC, Polatin P, Gajraj N, Deschner M, et al. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2004 May;27(5):440–59. Available from: https://doi.org/10.1016/j.jpainsymman.2003.10.009

Heit HA, Gourlay DL. Urine drug testing in pain medicine. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 2004 Mar;27(3):260–7. Available from: https://doi.org/10.1016/j.jpainsymman.2003.07.008

Christo PJ, Manchikanti L, Ruan X, Bottros M, Hansen H, Solanki DR, Jordan AE, Colson J. Urine drug testing in chronic pain. Pain physician. 2011 Mar 1;14(2):123-43.

Reisfield, MD GM, Bertholf PhD R, Barkin, MBA, PharmD RL, Webb, PhD F, Wilson, MD G. Urine drug test interpretation: What do physicians know? Journal of Opioid Management [Internet]. Weston Medical Publishing; 2007 Mar 1;3(2):80. Available from: https://doi.org/10.5055/jom.2007.0044

Argoff CE, Brennan MJ, Camilleri M, Davies A, Fudin J, Galluzzi KE, et al. Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation. Pain Medicine [Internet]. Oxford University Press (OUP); 2015 Dec;16(12):2324–37. Available from: https://doi.org/10.1111/pme.12937

Candy B, Jones L, Goodman ML, Drake R, Tookman A. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Candy B, editor. Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2011 Jan 19; Available from: https://doi.org/10.1002/14651858.cd003448.pub3

Food and Drug Administration Requires Strong Warnings for Opioid Analgesics, Prescription Opioid Cough Products, and Benzodiazepine Labeling Related to Serious Risks and Death From Combined Use. Journal of Pain & Palliative Care Pharmacotherapy [Internet]. Informa UK Limited; 2016 Oct;30(4):298–9. Available from: https://doi.org/10.1080/15360288.2016.1241336

Schuckit MA. Treatment of Opioid-Use Disorders. Longo DL, editor. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2016 Jul 28;375(4):357–68. Available from: https://doi.org/10.1056/nejmra1604339

Gourlay DL, Heit HA, Almahrezi A. Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain. Pain Medicine [Internet]. Oxford University Press (OUP); 2005 Mar;6(2):107–12. Available from: https://doi.org/10.1111/j.1526-4637.2005.05031.x

Gourlay D, Heit H. Universal Precautions: A Matter of Mutual Trust and Responsibility. Pain Medicine [Internet]. Oxford University Press (OUP); 2006 Mar;7(2):210–1. Available from: https://doi.org/10.1111/j.1526-4637.2006.00114.x

Gourlay DL, Heit HA. Universal Precautions Revisited: Managing the Inherited Pain Patient. Pain Medicine [Internet]. Oxford University Press (OUP); 2009 Jul;10(suppl 2):S115–S123. Available from: https://doi.org/10.1111/j.1526-4637.2009.00671.x

Substance Use Screening & Assessment Instruments Database. 2017. http://lib.adai.washington.edu/instruments . Accessed April 1, 2018.

American Society of Pain Medicine. Agreement on controlled substances therapy for chronic pain treatment. http://www.painmed.org/library/clinical-resources . Accessed April 1, 2018.

SAMHSA. SBIRT: screening, brief intervention, and referral to treatment. https://www.integration.samhsa.gov/clinical-practice/sbirt. Accessed April 1, 2018.

Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011.

Elliott AM, Smith BH, Penny KI, Cairns Smith W, Alastair Chambers W. The epidemiology of chronic pain in the community. The Lancet [Internet]. Elsevier BV; 1999 Oct;354(9186):1248–52. Available from: https://doi.org/10.1016/s0140-6736(99)03057-3

Crombie IK. Epidemiology of persistent pain. In: Jensen TS, Turner JA, Wiesenfeld-Hallin Z, eds. Proceedings of the 8th World Congress on Pain. Seattle: IASP Press, 1997; 53–61

Опіоїди в лікуванні неспецифічного гострого та хронічного болю



How to Cite

Dmytriiev DV, Zaletska OA, Bortnik DI. Opioids in the treatment of non-specific acute and chronic pain. PMJUA [Internet]. 2019 Apr. 29 [cited 2023 Feb. 8];4(1):22-36. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/188



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