| Popis: |
U se of opioid analgesics in management of chronic nonmalignant pain, as in any other intervention, must ultimately be viewed in terms of effects on patient performance. Proponents of opioid use under appropriate safeguards1-4 take the position that the choice is an option to consider under certain circumstances. These circumstances include careful weighing of psychological and social factors in the patient’s context. The focus of their position is that opioid usage does not necessarily impair patient ability to function, or does so only to a degree that is “cost effective,” in terms of suffering and the meeting of life’s obligations, when weighed against what is anticipated were they not used. The factor to weigh is maximum function versus minimal suffering. They have also argued that opponents of opioid use draw on “nonmedical considerations,” including reluctance to use on the basis of morality issues. Portenoy3 for example, mentions “stigma attached to these drugs by their potential for abuse.” Their position also seems to imply that opponents may tend to an “all-or-none” perspective in which such moral or ethical issues, when invoked, fail to consider whether patient performance is enhanced or, at the least, not compromised. These are valid points. There are social and political factors influencing the use of opioids. Legal criteria may fail to differentiate medically prescribed usage dictated by professionals from drug usage on a nonprescribed basis. This may result in excessive constraints on their use. Resort may also be made to law or to agency policy to restrain prescription of prescribed opioids. |
