Drugs
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Successful pain management using opiates requires both an analgesic with sufficient intrinsic activity and an effective administration system. Most instances of unsatisfactory pain control, however, are due to failure to achieve and maintain adequate blood concentrations of the chosen drug. Newer techniques of administration aim to overcome this problem. ⋯ In the management of acute severe pain, sublingual and intravenous opiates--self-administered as needed, or given by mandatory dosing schedules--have also been shown to overcome the limitations of intermittent intramuscular injections. A further novel development, stemming from basic neuroscience research, is the selective application of opiates to the spinal cord via the epidural or intrathecal route. This controversial technique has led to major improvements in treatment of some types of acute and chronic pain.