What is the case for prescribing long-acting opioids over short-acting opioids for patients with chronic pain? A critical review.
BACKGROUND
Effective pain management requires appropriate patient assessment, ongoing reassessment, and an understanding of the options available for the treatment of patients with chronic pain. Opioids have long been an important option in the management of moderate to severe chronic pain, but optimal use requires understanding the variety of choices currently available.


METHODS
Literature search was carried out using PubMed. Search terms included "steady state," "pharmacokinetics," "pharmacodynamics," "chronic non-cancer pain," "sustained release opioid," "extended release opioid," "controlled release opioid," "morphine," "oxymorphone," "hydromorphone," "oxycodone," and "fentanyl."


RESULTS
This search found 12 chronic pain studies that compared short- and long-acting opioids head-to-head. These were supplemented with representative studies from the chronic pain literature.


CONCLUSIONS
The objective of this article is to review clinical data for the use of long-acting and short-acting opioids in a variety of chronic noncancer pain conditions. Although some patients with chronic pain appear to prefer short-acting opioids, many patients receiving long-acting opioid formulations show improved treatment responses and better perception of quality of life. In addition, the sustained reductions in pain seen with long-acting opioid formulations may promote patients' focus on daily activities rather than on their pain, thereby improving therapy adherence and reducing pain-related anxieties.


CONCLUSIONS
Long-term clinical trials of these formulations are needed to allow clinicians to make informed decisions about which patient groups might benefit most from these formulations.
Rauck
Richard L
RL
Medical Director, Carolinas Pain Institute, Center for Clinical Research, Winston-Salem, North Carolina 27103, USA. rrauck@ccrpain.com
D000700:Analgesics / Q000008:administration & dosage* / Q000097:blood; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood; D002908:Chronic Disease; D016208:Databases, Factual / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D006801:Humans; D010146:Pain / Q000097:blood / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D013997:Time Factors
D000700:Analgesics; D000701:Analgesics, Opioid