The use of oral opioids in patients with chronic non-cancer pain. Management strategies.
BACKGROUND
The use of oral opioids in non-cancer pain is increasing, but it is not clear that this is improving outcomes for patients. These management strategies were developed as a consensus view between the two authors, who are both Directors of the Australian Pain Society. The strategies were subsequently reviewed and approved by the other Directors of the Society: four anaesthetists specialising in pain management, a pharmacist, a rheumatologist, two rehabilitation physicians and an occupational therapist.


METHODS
A MEDLINE search of the literature since 1966 produced 163 relevant articles, including two randomised controlled trials of oral opioids in non-cancer pain.
A small group of patients with chronic non-cancer pain can benefit from the use of oral opioids. Thorough attention to diagnosis and patient history must precede any decision to prescribe opioids. Patients should be psychologically stable. Patient and doctor should-agree beforehand on how to assess the outcome of therapy. Only one doctor (the patient's regular primary carer or pain specialist) should prescribe opioids and assess the response. Sustained release morphine preparations are the drug of choice. A trial of therapy, with goals and endpoint agreed between patient and doctor, should precede any decision to prescribe opioids in the long term.
Graziotti
P J
PJ
Department of Pain Management, Sir Charles Gairdner Hospital, Perth, WA.
Goucke
C R
CR
D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D011307:Drug Prescriptions; D006801:Humans; D007258:Informed Consent; D008487:Medical History Taking; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000523:psychology
D000701:Analgesics, Opioid