Opioid therapy
This chapter on opioids is in two parts: basic science and clinical. It includes the current evidence on where and how opioids work to mediate analgesia, non-analgesic effects, and unwanted side effects. In addition, the activity and impact of opioids in brain networks is discussed. These complex dynamic concepts are explained through functional magnetic resonance imaging findings and enables a greater understanding of opioid mechanisms. Mechanism and evidence of less studied side effects such as opioid-induced hyperalgesia along with immune and endocrine side effects are examined. Current genomic evidence and clinical application of this is discussed. The clinical part of the chapter gives complete information on the pharmacology of all opioids which are in clinical use, along with detailed information on when to prescribe and how to prescribe effectively and safely. Finally, the challenges of opioid prescribing in the twenty-first century are addressed. Identification of patient risk factors and appropriate prescribing and monitoring are presented in an agreed and practical way.