ABSTRACT
Opioid drugs are the most effective analgesics we know, but their use is limited by several liabilities, including their propensity to produce addiction. Despite decades of search for therapeutic agents that might provide analgesia without tolerance, dependence, and addiction, or other adverse effects, standard opioidsb remain the treatment of choice for severe pain of any origin. This supremacy persists because, unlike other drugs with analgesic properties, opioids can be titrated to achieve comfort, at least in the case of acute severe pain, with no strict ceiling dose. There is little debate about using opioids for visceral pain in hospitalized patients with pain of acute onset or an exacerbation of a chronic painful condition, and years of experience confirm that this practice is generally effective and safe, and bears minimal risk of addiction (1). The same is true of cancer-related pain treatment. However, long-term treatment of visceral pain with opioids is far from straightforward, not least because of a high risk of addiction that arises because many chronic visceral pain conditions share the comorbidities of addiction-depression, anxiety, posttraumatic stress disorder, somatoform disorder, personality disorder, and history of sexual abuse (2,3). Thus, while opioid therapy for acute visceral pain is relatively straightforward, the issues surrounding longer-term opioid therapy for visceral pain present a challenge in terms of balancing comfort and function in these complex patients.
