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Pain and opioids 

Pain and opioids
Chapter:
Pain and opioids
DOI:
10.1093/med/9780198714750.003.0012
Page of

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date: 14 December 2018

Chapter 12 of Addiction Medicine covers the challenging topic of pain and opioids. It emphasizes the distinction between physiological dependence and the clinical syndrome of opioid dependence (addiction). The place of opioids in pain management is outlined and the value of these drugs in managing both pain and the affective component of pain is emphasized. However, repeated opioid use may lead to opioid-induced hyperalgesia, withdrawal features, and the cognitive behavioural and physiological constellation of the dependence syndrome. The section on epidemiology demonstrates a steady increase in the prescribing of pharmaceutical preparations globally with a corresponding increase in morbidity and mortality, often through diversion to the illicit market. Practical tips to identify the dependence syndrome in opioid users are presented. The principles of management of chronic pain and opioid dependence are outlined and also how to manage acute pain in people with a history of opioid dependence.

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