Opioids in chronic non-cancer pain.
BACKGROUND
The use of chronic opioid therapy for chronic non-cancer pain is growing and is now accepted as an effective treatment modality.


METHODS
Although there are guidelines and reviews for chronic opioid therapy for chronic non-cancer pain patients, physicians may still have concerns and be reluctant to prescribe strong opioids for chronic non-cancer pain. Common issues and concerns when prescribing opioid for chronic pain management are reviewed and discussed. The literature search was done using Medline with key words 'chronic non-cancer pain', 'chronic opioid therapy', 'effectiveness', 'opioid tolerance', 'opioid-induced hyperalgesia', 'adverse effect', 'opioid dependency', 'addiction', 'monitoring', 'opioid contract' and various combinations with these key words. Studies from 1990 - 2010 have been included. This article helps readers to update, clarify and understand the common concerns when using opioid for chronic non-cancer pain. Clinical effectiveness and adverse effects with chronic opioid therapy, opioid tolerance and opioid-induced hyperalgesia, opioid dependency and addiction, monitoring during chronic opioid use, and opioid contact are discussed in detailed.


CONCLUSIONS
Not much strongly positive data supports the long-term use of opioids for pain relief, and the evidence for an improvement in functional activity is inconclusive. With careful selection of patients, meticulous prescription and monitoring protocol, chronic non-cancer pain patients who are likely to benefit from potent opioids should not be prevented from obtaining this treatment.
The University of Hong Kong, Queen Mary Hospital, Department of Anaesthesiology, Room 424, Block K, 102 Pokfulam Road, Hong Kong, China.
Bob Kwok Bun
BK
Chan
Lee Ka
LK
Tam
Chun Yin
CY
Wat
Yu Fai
YF
Chung
Siu Lun
SL
Tsui
Chi Wai
CW
Cheung
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003071:Cognition; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D016896:Treatment Outcome
D000701:Analgesics, Opioid