opioids

Patient’s rights mandate that every patient in chronic pain has the right to receive proper and effective treatment. It is widely acceptable that opioids can significantly improve the patient’s quality of life, irrespectable of the etiology of pain, either cancer or non-cancer.

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Opioid analgesics are widely accepted as first-line treatment for moderate to severe cancer pain: while their use in patients with non-cancer pain syndromes has increased substantially over the last years. However, opioid analgesia produces numerous adverse effects. These effects have a negative impact on patient’s quality of life, may impair adherence to treatment and finally limitate opioid use.

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Opioid analgesics have finally joined the treatment of chronic non-cancer pain. In many cases, the problems that emerge from long-term use of opioids, can outweigh the benefits from its use. These problems usually refer to somatic disturbances but quite often they affect the psychological milieu.

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Opioid use for cancer pain is well established in medical literature. Recommended by the european guidelines (European Society for Medical Oncology - ESMO, European Association for Palliative Care – EAPC), the World Health Organization (WHO) analgesic ladder remains the gold standard in cancer pain management.

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The issue of cerebral circulation and oxygen delivery to the brain requires constant vigilance for the clinician in the ICU, the trauma unit and the neurosurgical operation suite. These patients are administered anaesthetic medications that affect cerebral physiology by a lot of different and some times unexplored mechanisms.

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Cell protection against hypoxia can be mediated by brief periods of sublethal ischemia, a phenomenon called ‘preconditioning’. The molecular mechanisms that are responsible for cell protection are extremely complicated; however, extensive research in molecular biology and cellular physiology has uncovered many different signaling pathways, especially in cardiac tissues.

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