Opioids and Chronic Pain: Where Is the Balance?
Chronic opioid therapy (defined as greater than 3 months on opioids) is a common practice for those with non-cancer pain, cancer survivors with treatment-related pain, and individuals with cancer undergoing disease-modifying therapy with a survival that can be for a year or more. Recent studies have found unique long-term toxicities with opioids which reduce the utility of opioid therapy in chronic pain. The risk of addiction, depression, central hypogonadism, sleep-disordered breathing, impaired wound healing, infections, cognitive impairment, falls, non-vertebral fractures, and mortality are increased in populations on long-term opioids. Factors associated with these risks are related to dose, duration of opioid therapy, type of opioid, and formula (long-acting, short-acting). This state-of-the-art review discusses the risks and benefits of chronic opioid therapy and strategies to increase utility and diminish risks to opioid therapy.
Department of Palliative Care, Geisinger Medical Center, Danville, PA, 17822, USA. mdavis2@geisinger.edu.
Mellar P
MP
Davis
Department of Palliative Care, Geisinger Medical Center, Danville, PA, 17822, USA.
Zankhana
Z
Mehta
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management
D000701:Analgesics, Opioid
Cognitive; Depression; Fall fracture; Infection; Intensity; Opioid; Pain; Sleep-disordered breathing; Wound healing