Abstract
The role of antidepressants and anticonvulsants in the management of neuropathic pain has been well established. However, up to 50% of patients obtain inadequate pain relief with the use of either or both of these agents; in this subpopulation, an opioid analgesic may be beneficial. There is clear evidence that opioid analgesics are efficacious in the management of neuropathic pain, but there is controversy as to the balance between analgesia and adverse effects. Opioid treatment may require higher doses than other kinds of drug therapies, thereby increasing the risk of opioid-related side effects. Psychological dependence or addiction, however, is not usually an issue in pain management with opioid analgesics. The extant literature strongly suggests the trial of an opioid analgesic in the management of neuropathic pain if adjuvant analgesics fail to provide adequate pain control. Failure of one opioid warrants a trial of another opioid because their effectiveness can vary among patients; the results are based on physiochemical properties of the drug and idiosyncratic reactions of the patient. Neuropathic pain can be a difficult problem to manage, and sometimes the use of an opioid analgesic can make the difference between bearable and unbearable pain so that patients can get on with their lives.