title: Opioids and chronic pain: using what we know to change what we do.
abstract: The review draws together firm conclusions about effectiveness and harms of prolonged opioid treatment and explores the complex nature of chronic pain.
  
  
  
  The literature may now explain why long-term opioid treatment has failed to live up to its late 20th century promise. An understanding of sources of bias in clinical trials has allowed a more detailed and accurate picture of the role of opioids in chronic pain to emerge and there is recognition that populations in clinical trials differ in very important ways to those given opioids in clinical practice. The prevalence of psychiatric and emotional comorbidities in patients with long-term pain is identified in clinical populations and the influence of these on the experience of pain and the outcomes of therapy are well described. This improved understanding of the role of opioids and the complexity of the pain experience should allow more appropriate assessment of patients and better focused treatment planning, but the influences on prescriber behaviour are many and varied and change in prescribing practice may be difficult to achieve.
  
  
  
  Clinicians treating patients with chronic pain need to understand the many contributors to the reported experience of pain. A shared understanding of this complexity helps to set prescriber and patient expectations appropriately. If medications are used as part of the treatment plan they should only be prescribed if they produce useful pain relief and meaningful improvements in quality of life.
authors.affiliation: Pain Clinic, Southmead Hospital, Bristol, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Stannard
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid