Controlled Substance Management in Chronic Pain by Peter S. Staats & Sanford M. Silverman

Author:Peter S. Staats & Sanford M. Silverman
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Edema

It has been assumed that opioids cause peripheral edema. The mechanism that causes edema is uncertain, but theories suggest that opioids stimulate histamine release from mast cells causing amplified venous permeability leading to fluid retention or increased secretion of antidiuretic hormones causing fluid accumulation.

Peripheral edema occurs in 6.1–21.7 % of intrathecal opioid-treated cases. Research has identified intrathecal morphine to be the cause of edema in only 3 % of cases.

Edema is increasingly identified as a potential adverse effect of intraspinal opioid infusion treatment. Chronic leg edema is an identified precursor for cellulitis. Many physicians have controlled peripheral edema by titrating to lower opioid doses or by switching to non-opioid analgesia. Research has shown that studies of opioid infusion-related edema have been well controlled by intrathecal baclofen and clonidine, alternatively, to provide spinal antinociception in cases where intraspinal opioids fail due to intolerable pharmacological adverse effects.

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