Douleur et opioïdes forts : des recommandations d'experts aux nouvelles réflexions. Du bon usage des opioïdes

Strong opioids are prescribed for a long time to relieve cancer pain. For over a decade, some guidelines are available for using these molecules in various non-cancer pains. Nevertheless, even today, strong opioids are sometimes inappropriately used by prescribers with, on the one hand, phenomenons of “opiophobia” inducing a potential pain chronicity and, conversely, unjustified “over-prescriptions” of these molecules increasing the risk of patients addiction. Along with these behaviors, scientific pain research improvements have enabled us to refine our knowledge of pathophysiological pain mechanisms and lead us to rethink the paradigms of pain management used until now: we move towards modifying the framework of the analgesics ladder presented by the WHO in 1986 and revisited in 1997 to the benefit of a new analgesic classification according to the underlying mechanism of the patient's pain. The objective of this article is to give prescribers a clearer vision of the available French guidelines in various pain situations and to share a new thinking over pain management which moves to customization of the analgesic treatment according to patients pain characteristics and patients expectations. The ultimate goal is to change “opiophobia/opiophilia” attitudes highly detrimental to effective relief of patients.