Current management of opioid-related side effects

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such si de effects is influenced by the extent of disease, the patient's age, the p resence of coexistent renal and hepatic disease, pulmonary disease, and cog nitive dysfunction, a prior opioid history, use of polypharmacy, dose of op ioid drug being administered, and the route of administration. The most com mon opioid-related side effects are constipation, sedation, nausea, vomitin g, and cognitive disturbance. Less frequent side effects include urinary re tention, perceptual distortion, respiratory depression, and myoclonus. In a n era emphasizing quality of life in cancer care, clinicians need to be awa re of (I)factors that influence the prevalence of opioid-related side effec ts, (2) effective management strategies, and (3) how to recognize when symp toms are opioid related as opposed to caused by other etiologies, such as t he patient's disease process or treatment approaches. The use of validated instruments and repeated assessment enhances such an evaluation and subsequ ent treatment. This article delineates the current optimal management of op ioid-related nausea and vomiting, constipation, cognitive side effects, myo clonus, arid respiratory depression.