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Previous Volume 349:1943-1953 November 13, 2003 Number 20 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Opium is a bitter, brown, granular powder derived from the seedpod of the poppy (Papaver somniferum). People have used opium for the relief of pain and suffering for thousands of years. Before the 19th century, opium was cultivated and used chiefly in the Middle East, whereas in Europe and the United States it was a luxury available mainly to the elite. During the 19th century, several historical events conspired to make opium and other opioids more readily available. The production of opium increased rapidly, and after the morphine alkaloid was identified in 1806 pharmacologic production of opioid drugs . . . [Full Text of this Article]

Current Practice

Clinical Studies

Prolonged, High-Dose Opioid Therapy

Mechanisms of Failed Analgesia and Adverse Outcomes

Opioid Tolerance

Opioid-Induced Abnormal Pain Sensitivity

Opioid-Induced Hormonal Changes

Opioid-Induced Immune Modulation

Clinical Implications

Relation of Apparent Tolerance to Pharmacologic Tolerance

Adverse Consequences of Prolonged, High-Dose Opioid Therapy

Limiting the Opioid Dose

            Drug Formulation

            Opioid Rotation

            Failure to Control the Dose

Conclusions

Source Information

From the Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School — both in Boston.

Address reprint requests to Dr. Ballantyne at the Massachusetts General Hospital Pain Center, 15 Parkman St., WACC 333, Boston, MA 02114, or at jballantyne@partners.org.

Related Letters:

Opioid Therapy for Chronic Pain
Hermos J. A., Klein M. J., Gajraj N., Ballantyne J. C., Mao J.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:840-842, Feb 19, 2004. Correspondence

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