The role of opioids in managing chronic non-cancer pain.
The use of opioids for the treatment of chronic non-cancer pain has become more widespread recently. Available data support the short-term use of opioids in clearly defined nociceptive and neuropathic pain states. Their use in 'pathological' pain states without a clear diagnosis, such as chronic low back pain, is more contentious. A decision to initiate opioid treatment in these conditions requires careful consideration of benefits and risks; the latter include not only commonly considered adverse effects such as constipation, but also opioid-induced hyperalgesia, abuse, addiction and diversion. Ideally, treatment goals should not only be relief of pain, but also improvement of function. Opioid treatment of chronic non-cancer pain requires informed consent by, and preferably a treatment contract with, the patient. Treatment should be initiated by a trial period with defined endpoints using slow-release or transdermal opioids. Ongoing management of the patient requires ideally a multi-disciplinary setting. Treatment should not be regarded as life-long and can be discontinued by tapering the dose.
Sng
Ban Leong
BL
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia.
Schug
Stephan Alexander
SA
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced; D017116:Low Back Pain / Q000188:drug therapy; D010148:Intractable Pain / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000517:prevention & control
D000701:Analgesics, Opioid