title: Issues in opioid management.
abstract: Although a universal consensus has evolved concerning the utility of opioids in cancer pain, the use of opioids for the treatment of chronic nonmalignant pain syndromes is much debated in the medical literature. Although for clinical, regulatory, and medicolegal reasons, many clinicians disagree with their use, others find them helpful, with little prevalence of abuse behaviors or intolerable adverse effects. In a review of this topic, several issues of relevance to management decisions, including efficacy, medication compliance, and safety, are evaluated. As a clinically distinct population among chronic pain sufferers, patients with arthritis-associated pain (including rheumatoid and osteoarthritis) are discussed separately. Particularly important issues with regard to prescribing decisions, including divergent goals and expectations, and factors associated with avoidance of withdrawal and addiction, are also evaluated to ensure that management of patients with nonmalignant chronic pain is optimized when opioids are considered.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Quentin Mease Hospital, Houston, Texas, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Bloodworth
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy; D001294:Attitude to Health; D002908:Chronic Disease; D006801:Humans; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010146:Pain / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011597:Psychomotor Performance / Q000187:drug effects; D016896:Treatment Outcome; D014481:United States
chemical_list: D000701:Analgesics, Opioid