Opioid/anxiolytic combo?

[netglow]

Anybody know of an opioid/anxiolytic combo they have seen used as a means of reducing dose of the opioid (Dilaudid) to reduce respiratory side effects (depression) and to synergistically help with pain/nausea/vomiting... that is effective? Give me some ideas? Reglan and Zofran not effective...

Any insight would be great from the all knowing all nurses folks.

[wtbcrna, MSN, DNP, CRNA]

Opioids aren't the end all of pain control....To reduce the amount of opioids Tylenol (which won't cause increased risk of bleeding at normal doses), low dose ketamine can reduce opioid tolerance and works on the NMDA receptors (very little side-effects at the lower doses...dysphoria etc.), tri-cyclic antidepresseants, and SSNRIs are all other choices to help with chronic pain. There are also physical therapies...TENs units, spinal cord stimulators...etc.

Long term opioid use can lead to hyperalgesia and overall opioid doseage should be reduced or eliminated as much as possible. The thing to remember about chronic pain or nausea is both are mulitmodal and often require multiple therapies, drugs/physical therapy etc, working on different receports/pathways to keep the symptoms under control.

By the way most anxiolytics and opioids share the same metabolic enzymes for breakdown so they act synergistically. It is not method I would recommend just reduce the overall opioid dose.