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  1. #1
    Junior Member Gayathriy's Avatar
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    Why is it that after 50 years of research there is no better opioid than morphine?

    What is your view? Do you think there is a better opioids than morphine and why?
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  2. #2
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    It depends on what you want to use it for and how long you want it to last.

    Morphine is actually a fabulous drug, IMO. Although it has many side-effects.

  3. #3
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    Depends what do you mean by 'better'?

    For concious sedation I prefer pethidine as it acts quicker and has a shorter duration of action. Many consider it 'better' in this context. Costs a lot though, while morphine is insanely cheap.

  4. #4
    Senior Member Varied A's Avatar
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    Oxycodone is (relatively) new and has advantages over morphine in some situations.
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  5. #5
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    Pethidine is a dirty drug and should be banned.

    Diamorphine and fentanyl are both 'stronger' than morphine if that is what you are asking.

  6. #6
    Senior Member yeliab_cram's Avatar
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    i dont think there are a great many people searching for 'better' painkillers when the opiates we have do the job pretty well. Most of the big drugs companies are playing in the realms of immunomodulation and chemotherapy where there is muchos money to be made.
    Marc

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  7. #7
    Member andy2's Avatar
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    The problems largely come down to biology and economics - the receptors which opioids act through ('opioid receptors') mediate both the analgesic effects or opioids and the side effects (nausea, sedation, respiratory depression etc...) - whilst there is some differences between the effects mediated by the various sub-classes of the receptors no one has yet designed a drug which is specific for the analgesic effects without the other side effects.

    The other issue is economics - morphine is cheap as chips, it works well and doctors are familiar with it. Millions of people get morphine based analgesia every year and it is effective. There are other forms of analgesia, but they are either expensive and cumbersome (epidurals), not as effective on their own and with their own side effects (e.g. Non-steroidals) or have similar or worse side effects (e.g. ketamine).

    Pain research is actually reasonably well funded, with a lot of work looking at chronic pain treatments - however most of the work on opioid based treatments has produced more potent opioids (fentanyl, remifentanil, sufentanil) which have great intra-operative use, but aside from fentanyl, tend not to be used in other situations due to the risks of overdose and respiratory depression.

  8. #8
    Junior Member Gayathriy's Avatar
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    Thankyou for your help!

    one more question: where will i be able to find the prices of different opioids? i want to be able to compare equidoses of the main ones.
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  9. #9
    Senior Member yeliab_cram's Avatar
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    the BNF
    Marc

    Academic Vascular Medicine & Surgery
    Currently: FY1 in Cardiology at the Leeds General Infirmary[/COLOR]

    "No matter where you go in life, always keep an eye out for Johnny, the tackling Alzheimer's patient" Dr Cox

    www.cuttingedgeleeds.co.uk
    Leeds University Medical School's Surgical Society

  10. #10
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    Tramadol is also allegedly a great complete opioid alternative - according to my current supervisor.

    it acts in 2 ways - 50% acts on opioid receptors, and 50% acts on noradrenaline and serotonin receptors, hence it also acts against neuropathic pain and gets involved in descending modulation, which helps inhibit pain.

    but as the guys say above there are loads (well, some) alternative opioids - fentanyl, alfentanil, buprenorphine, diamorphine, remifentanil, oxycodone and others which i can't be bothered to think of.....sorry


    If you are going to compare the price of equal doses then remember that drugs like fentanyl are more potent than plain old morphine, so you will need a smaller dose to get the same effect......just something to think about.
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