Review
Alternative opioids to morphine in palliative care: a review of current practice and evidence
M BarnettWalsgrave
Hospital, Coventry and University of Warwick
Correspondence to: Dr M Barnett, Centre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL, UK
Submitted 8 May
2000;
Accepted 31 October
2000
| The first 150 words of the full text of this article appear below. |
 |
Introduction |
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This is a review of current practice of opioid use in palliative care, conducted from the perspective of a practising clinician working in the increasingly complex area of symptom control. In examining alternative opioids to morphine, choice and availability of different drugs reflect the UK perspective. Some drugs or formulations may not be available elsewhere, but the principles discussed may hopefully still be applied.
The aims of this paper are several-fold:
| (1) | To present an overview of available opioids. |
| (2) | To consider factors affecting possible choice of opioid with particular reference to the palliative care setting.
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| (3) | To consider availability and limitations of current data which may affect evidence based decisions. |
| (4) | To comment on areas of interest for future clinical trials. |
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Terms of reference |
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OPIOID RECEPTORS AND EFFECTS
There are three main classes of opioid receptor: mu, kappa, and
delta (table 1), responsible for differing opioid effects. Opioid drugs
vary in their receptor affinity, thus affecting their principal actions
(table 2). The main site of action is the mu receptor, but some opioids
have more complex activity.
| Table Removed (Available Only in the Full Text) |
| Table Removed (Available Only in the Full Text) |
SIDE EFFECTS OF OPIOIDS
Side effects are common to all opioids, although to differing
degrees.
- Sedation
- Hallucinations
- Constipation
- Nausea/vomiting
- Urinary retention
- Myoclonus
- Paradoxical pain
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. . . [Full text of this article]
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