Der Schmerz
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It has been shown that an active metabolite- morphine-6-glucuronide-is formed in man after administration of morphine. In spite of the chemical variation, the glucuronide still possesses high affinity to opioid receptors and the polarity of the glucuronide does obviously not exclude penetration of the blood-brain barrier. ⋯ It can not be excluded at the moment that morphine-6-glucuronide will prove superior to morphine for long term treatment, since the kinetic behaviour excludes sharp undulations of the plasma concentration and probably of the concentration at receptor sites in the brain. It is speculated that this type of pharmacokinetic behaviour will reduce tolerance phenomena and abuse liability.
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Most pain in cancer should be easily relieved because it responds in a predictable way to opioid analgesic drugs. Some pains do not respond so well but can usually be ameliorated by the judicious use of adjuvant analgesics, non-drug measures, and the active involvement of the multidisciplinary team.
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Non-opioide analgesics have different pharmacological effects and different profiles of their risks. The life-threatening side effects i.e. agranulocytosis after administration of Dipyrone (Metamizol) are rare, but the must be known and cautions must be considered. On the other hand information must be given about the severe side effects following the not-recommended use i.e. end-stage renal disease after misuse of non-opioid analgesics, because these diseases are preventable.