Acute Medicine | Palliative care | Opioids in pain management: advanced knowledge

Opioids in pain management: advanced knowledge
Session overview
Description
This advanced session looks at the properties of the main opioids used in the UK, when to switch opioids, particularly in renal impairment, and when to use subcutaneous opioid preparations.

This session was reviewed by Rina Patel and Richard Kitchen, and last updated in September 2021.

Learning objectives
By the end of this session you will be able to:

• give examples of other 'strong' opioid preparations used in the UK
• list the opioids that are best tolerated in severe renal impairment, and explain why
• outline the main reasons why an alternative opioid to morphine may be considered
• describe some of the main indications for use of subcutaneous opioids in preference to oral analgesia

Prerequisites
Before commencing this session you should complete:

• Assessment of pain (215-0407)
• Principles of pain management (215-0408)
• Drug management of pain: core knowledge (215-0409)

The session, Drug management of pain: core knowledge (215-0409), provided a framework to help manage pain. It confirmed that morphine is the usual first choice 'strong' opioid for moderate to severe pain. The session also highlighted the importance of addressing psychosocial, spiritual and emotional concerns as an integral part of pain management.

This session looks at the more complex situation of when pain persists despite appropriate use of non-opioid analgesia. It looks at morphine and the other main opioids used in the UK and outlines their key properties. It explains when it may be appropriate to switch opioids, particularly in renal impairment.

Finally, this session discusses the circumstances when subcutaneous rather than oral opioid preparations can be the better choice for the patient, and re-iterates the importance of a holistic and multi-professional approach to pain management.