Analgesia, Opioids and the WHO Pain Ladder

Buckle up, this is a big one! (with a long intro, sorry about that).
In this episode we scrape the surface on the complicated world of pain management. This podcast is just a brief overview, including paracetamol/acetaminophen, opioids, gabapentinoids, and adjuvants.
This podcast is meant to complement further teaching on pain pathways/pathophysiology, pain management, and substance use disorders. The field is very complicated, and we can't cover it all in one podcast!
This episode also links in to the next podcast in the series on NSAIDs and Aspirin.

There were 3 things I forgot to elaborate on in the podcast whilst trying to keep it as short as possible
1. Morphine (and many other opioids) are renally cleared. In patient with poor renal function (eg. elderly with CKD, or people with AKI) morphine must be dose adjusted! Opioids are notorious for precipitating delirium in the elderly populations especially if they aren't dose adjusted, and this can also lead to overdose.
2. Gabapentinoids work through Ca2+ Channels in the ascending pathway. The reason this is important is calcium is used to trigger degranulation of neurotransmitter into the synapse - therefore blocking its influx prevents transmission of nociceptive signals via the ascending pathway.
3. Opioids are a common source of nausea! Some are more nauseating than others (Tramadol being notorious for it), check out our previous episode on antiemetics for more info. 

The show notes can be accessed for free at https://medtutes.wordpress.com/podcasts  
We also reference an article on Tox and Hound, accessible at https://emcrit.org/toxhound/mouddisorder  
The EM Cases podcast episode that inspired this topic is accessible at https://emergencymedicinecases.com/drugs-that-work-analgesics  

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