title: Opioid use in chronic non-cancer pain--part 1: known knowns and known unknowns.
abstract: BACKGROUND
  Opioids have a critical, time-limited role in our management of acute and terminal pain and an open-ended role in our management of opioid dependency. They also have a use in the management of chronic non-cancer pain.
  
  
  OBJECTIVE
  To provide an understanding of what is known, and what is not known, about the use of opioids in chronic non-cancer pain using an evidence-based approach.
  
  
  CONCLUSIONS
  For chronic non-cancer pain, the evidence base for the long-term use of opiates is mediocre, with weak support for minimal improvements in pain measures and little or no evidence for functional restoration. Much research and professional education in this field has been underwritten by commercial interests. Escalating the prescribing of opioids has been repeatedly linked to a myriad of individual and public harms, including overdose deaths. Many patients on long-term opioids may never be able to taper off them, despite their associated toxicities and lack of efficacy. Prescribers need familiarity with good opioid care practices for evidence-based indications. Outside these areas, in chronic non-cancer pain, the general practitioner needs to use time and diligence to implement risk mitigation strategies. However, if a GP believes chronic non-cancer pain management requires opioids, prescribing must be both selective and cautious to allow patients to maintain, or regain, control of their pain management.
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: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D019317:Evidence-Based Medicine; D058006:General Practice; D006801:Humans; D009369:Neoplasms / Q000150:complications; D009293:Opioid-Related Disorders / Q000453:epidemiology; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology; D015995:Prevalence; D018570:Risk Assessment
chemical_list: D000701:Analgesics, Opioid