The synthetic opioid analgesic pethidine is effective in treating short-term acute pain but has no role to play in chronic pain therapy.
If pethidine is used to treat recurrent pain, such as migraine, patients can become too reliant upon it. Long-term use can cause accumulation of norpethidine with potentially toxic consequences. The resultant drug-seeking behaviour could be very hard to treat, warns Dr. Allan Molloy, Director of the Chronic and Cancer Pain Program, University of Sydney Pain Management and Research Centre, Australia.
Opioids are often inappropriately prescribed for patients with social problems, high levels of emotional distress and unclear medical diagnoses, he added. It is always important to rule out new or undiagnosed pathology and to consider any psychosocial factors.
The drug should not be used for more than 72 hours for acute pain. Pethidine's useful analgesia lasts for two to four hours after parenteral administration and is effective preoperatively, and for intra- and postoperative pain relief. Alternative treatments include other opioid analgesics, non-steroidal anti-inflammatories, simple analgesics and regional anaesthetic techniques.
In chronic pain, which is likely to be less sensitive to opioids than pethidine, there was "a myriad of other options." These include including spinal implants, long-acting opioid preparations for nociceptive pain or newer drugs for neuropathic pain. Guidelines published in 1997 do not support the use of regular parenteral opioids for chronic non-malignant pain.
Patients receiving regular pethidine for chronic pain should have their condition re-evaluated by a multidisciplinary pain management team, if possible. Otherwise, any unhelpful beliefs and behaviours should be addressed in addition to any nociception or neuropathy. That would usually broaden the treatment options.
Pain is "a multidimensional experience," Dr. Molloy said. Therefore, treatment should not be continued with one modality unless the response was rapid and sustained. Failure to instruct patients on self-management might reinforce their excessive reliance on others instead of managing their own pain.
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