The common adverse effects of opioid therapy include nausea and vomiting, and, of course, constipation. Sedation, also, although this could be the result of pain-induced sleep deprivation, and now that you’re treating the pain, they’re catching up on their sleep. Generally, that gets better over the first few days of therapy, but it may not improve. We could see some confusion or even some frank delirium. We can see itching; it’s important to ask about that. In terms of long-term adverse effects, we’re learning more and more about hypogonadism, for example, and the immunosuppressive effects of the opioid. We are seeing patients on long-term opioid therapy and it is important to bear those in mind as well. And any discussion of adverse effects of opioid therapy would be remiss if you did not include the risk of misuse, abuse, diversion, and unintentional death.
It’s very important when you pick an opioid for a particular patient to ask about previous exposure to opioids, what’s worked for them and have they had any adverse effects. I think today’s savvy pain practitioner has to be equally skilled at the therapeutic management of pain as well as the psychosocial aspects of managing these drugs which could be problematic.