title: Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong.
abstract: Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain. It also aims to provide useful recommendations for the appropriate, effective, and safe use of such therapy in the management of chronic non-cancer pain in adults. Physicians should conduct a comprehensive biopsychosocial evaluation of patients prior to the commencement of opioid therapy. When opioid use is deemed appropriate, the patient should provide informed consent within an agreement that specifies treatment goals and expectations. A trial of opioid can be commenced and, provided there is progress towards treatment goals, then chronic therapy can be considered at a dose that minimises harm. Monitoring of effectiveness, safety, and drug misuse should be continued. Treatment should be stopped when opioids become ineffective, intolerable, or misused. The driving principles for opioid prescription in chronic pain management should be: start with a low dose, titrate slowly, and maintain within the shortest possible time.
authors.affiliation: Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: C W
authors.initials: CW
authors.lastname: Cheung
authors.affiliation: Department of Anaesthesiology, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: T Cw
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong.
authors.forename: P P
authors.initials: PP
authors.lastname: Chen
authors.affiliation: Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: M C
authors.initials: MC
authors.lastname: Chu
authors.affiliation: Department of Pharmacy, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: W Cm
authors.initials: WC
authors.lastname: Chui
authors.affiliation: Consultation and Liaison Psychiatry Team, Kwai Chung Hospital, Kwai Chung, Hong Kong.
authors.forename: P T
authors.initials: PT
authors.lastname: Ho
authors.affiliation: Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: F
authors.initials: F
authors.lastname: Lam
authors.affiliation: Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: S W
authors.initials: SW
authors.lastname: Law
authors.affiliation: Occupational Therapy Department, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: J Ly
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: S Hs
authors.initials: SH
authors.lastname: Wong
authors.affiliation: Department of Pharmacy, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: V Kc
authors.initials: VK
authors.lastname: Wong
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006723:Hong Kong; D006801:Humans; D007258:Informed Consent; D009293:Opioid-Related Disorders / Q000517:prevention & control; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid
keywords: Analgesics, opioid/therapeutic use; Chronic pain/drug therapy; Practice guidelines as topic/standards