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Role of step 2 opioid analgesics in mild-to-moderate pain intensity treatment

    Wojciech Leppert

    Wojciech Leppert is Chair of the Department of Palliative Medicine at Poznan University of Medical Sciences (Poland), teaching palliative medicine and supportive care medical and nurses students from Poland as well as English-speaking students from all over the world. He is also actively involved in the care of patients at home hospice, outpatient clinic and the inpatient palliative care unit. He is a consultant in clinical oncology radiotherapy and palliative medicine.

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    Published Online:27 Feb 2012https://doi.org/10.2217/ebo.11.250
    Abstract:

    Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant analgesics. In most cancer patients, pain is successfully treated with step 3 opioids (opioid analgesics for moderate-to-severe pain intensity, strong opioids). Step 2 opioid analgesics (weak opioids) are usually recommended in the treatment of cancer patients with pain of mild-to-moderate intensity. Debate continues whether the second step of the WHO analgesic ladder comprising opioids such as tramadol, codeine and dihydrocodeine is still needed for the treatment of cancer and chronic pain due to a similar efficacy of low doses of opioids for moderate-to-severe pain intensity. However, many patients with mild, moderate and, in some cases, strong pain intensity are still successfully treated with step 2 opioids alone or in combination with nonopioids. Step 2 analgesics are metabolized through CYP2D6, which is an important enzyme for approximately 25% of all drugs administered in clinical practice. The aim of this chapter is to review in short data on pharmacokinetics, pharmacodynamics and adverse effects of opioids for mild-to-moderate pain, taking into consideration the impact of CYP2D6 polymorphism.

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