Opioid Therapy by Anesthesiologists in Palliative Care and Pain Medicine

Abstract

  At present, there are many facilities with anesthesiologists who, as pain management specialists, are trusted and of whom expectations are high. Away from the operating theater, the anesthesiologists is in charge of the long-term management of pain such as cancer pain, acute pain, and chronic non-cancerous pain. There is no question as to the utility of opioids for the first two types of pain. In particular, using patient-controlled analgesia (PCA) to administer opioids to control the breakthrough pain apparent in nociceptive pain has proven to be the most effective anesthetic technique. Also, recent elucidation of the molecular mechanisms underlying chronic pain has promoted wider recognition of the utility of opioids for the treatment of chronic non-cancerous pain. For long-term pain management with opioids to be successful, knowledge of the pharmacology of opioids via the various access routes as well as of possible secondary effects is required, not to mention the countermeasures to be taken. It is also necessary to recognize the kinds of medical accidents that can occur and to decide on how to deal with them. Finally, there is also the requirement of a far-reaching understanding and conception of both the primary disease and the patient's social environment.