[Opioids and new trends in pain therapy]. / Opioidy a nové trendy v lécbe bolesti.

Opioids are well known for their ability to reduce the perception of pain without a loss of consciousness. However, the influence of opioids on organism is very complex. Clinical pharmacology of currently available opioid analgesics is determined by three major factors - their opioid receptor properties, pharmacokinetic properties and genetic polymorphism in the opiate receptor and cytochrome P450 isoform. In acute severe pain are opioids very efficient. Long-term experience with opioid analgesia in patients with cancer pain has shown high favorable risk/benefit ratio. However, the treatment with opioids has its issues. Life expectancy of chronic pain patients is temporarily unlimited and for that reason the time horizon of opioid therapy is unlimited as well. In comparison with cancer pain opioid responsiveness to chronic non-cancer pain is somewhat different. Clinical experience has shown that exceeding of medium-sized doses of opioids in the treatment of chronic non-cancer pain does not lead to further improvement of analgesia, but only increases degree of physical dependency and tolerance. The most important step is to choose the right patient. Subsequently, the success of opioid therapy depends on a careful search of balance between pain, opioid dosage and analgesia with emphasis on individualization and attention to the prevention and management of side effects.

[Chronic pain therapy in inflammatory rheumatic diseases]. / Lécba chronické bolesti u zánetlivých revmatických onemocnení.

Chronic pain is a common health problem related to most of inflammatory rheumatic disorders. It is pain that has persisted for at least 3 month and cannot be fully relieved by standard pain medication. 40-60 % of patients do not have adequate relief of their pain. Paramount in the management of chronic pain patients is assessment of the pain and its impact on physical and psychosocial functioning. Multidisciplinary and multimodal approach is of vital importance. Non-steroidal anti-rheumatic drugs (NSA) have been used mainly due to their strong analgesic effect, especially in the treatment of acute pain as well as their anti-inflammatory effect in the treatment of chronic i pain. Long-term systemic administration of NSA may be associated with a number of serious side effects, which significantly limit NSA use in long term therapy. Due to opiophobia, opioids are insufficiently used treatment modality. Knowledge about pain and its management, as well as an awareness of barriers to effective pain therapy, are important not only for pain specialists but also primary care physicians.Key words: chronic pain - non-steroidal antirheumatic drugs - opiophobia - opioids - pain assessment - paracetamol - rheumatoid arthritis.