title: Opioid use in chronic non-cancer pain--part 2: prescribing issues and alternatives.
abstract: BACKGROUND
  Managing pain requires time and effort to attend to its biopsychosocial characteristics. This requires proper planning and a whole-of-practice approach.
  
  
  OBJECTIVE
  This article describes how to prepare your practice for quality chronic pain care, and details a non-judgemental and effective management approach, including the minimisation of opioid harms.
  
  
  CONCLUSIONS
  It is helpful to have a consistent, whole-of-practice approach when a patient new to the practice presents with a compelling case for opioids. Assessing patients with chronic pain includes a full medical history and detailed examination according to a biopsychosocial approach and applying 'universal precautions' to make a misuse risk assessment. A management plan should consider a range of non-opioid modalities, with a focus on active rather than passive strategies. Integrated multidisciplinary pain services have been shown to improve pain and function outcomes for patients with complex chronic pain issues, but access is often limited. Time-limited opioid use is recommended with initial and regular monitoring, including pain and function scores, urine toxicology, compliance with regulatory surveillance systems and assessment for adverse reactions and drug related aberrant behaviours. When ceasing prescribing, opioids should be weaned slowly, except in response to violence or criminal activity.
authors.affiliation: Drug and Alcohol Clinical Services, Hunter New England Local Health District, Taree, New South Wales, Australia. simon@nunet.com.au
authors.forename: Simon
authors.initials: S
authors.lastname: Holliday
authors.forename: Chris
authors.initials: C
authors.lastname: Hayes
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunlop
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D002985:Clinical Protocols; D032982:Contracts; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008487:Medical History Taking; D055118:Medication Adherence; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010808:Physical Examination; D018570:Risk Assessment
chemical_list: D000701:Analgesics, Opioid