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The use of nonopioid drugs in management of chronic orofacial pain

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By Zuniga JR • www.ProHealth.com • September 10, 1998


Although controversial, opioid analgesics have been prescribed
for patients with chronic facial pain. Based primarily on
survey data and a few well-controlled clinical trials,
long-term opioid treatment provides adequate pain reduction in
41% to 100% of patients with chronic nonmalignant pain.
However, only 25% of chronic facial pain patients reported
adequate pain relief with chronic opioid treatment. Work,
home, and school function are generally reestablished or
maintained during chronic opioid treatment, but 25% to 38% of
patients remain dysfunctional, and one study indicated that
20% of patients became dysfunctional during treatment. Chronic
opioid treatment is associated with many transient side
effects; constipation, dizziness, nausea, vomiting, itching,
and fatigue have been reported in 5% to 42% of patients taking
opioids over 1 year. Although survey studies suggest that the
risks of addiction are low in typical patients, drug abuse
rates up to 17.3% and prescription abuse rates up to 27.6%
were reported within groups of chronic opioid users. Chronic
opioid use induces analgesic tolerance and physical
dependence, which may result in a serious abstinence syndrome
in users and children born to users. Chronic opioid use also
may induce harmful immune system changes, diminish cognitive
and motor function, and produce nociceptive hyperexcitability.
This article shows that the use of long-term opioids for
chronic facial pain is not justified based on the available
data. Despite these perceived problems, there is anecdotal
evidence that chronic facial pain patients will respond
positively to opioid analgesics. In our experience, the pain
assessment scale and a modification of the World Health
Organization's three-step analgesic ladder, which prescribes
nonopioid analgesics, can be the starting point for the
successful management of chronic facial pain.




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