The role of opioids in managing chronic non-cancer pain.
- Author:
Ban Leong SNG
1
;
Stephan Alexander SCHUG
Author Information
1. Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia.
- Publication Type:Journal Article
- MeSH:
Analgesics, Opioid;
adverse effects;
therapeutic use;
Humans;
Hyperalgesia;
chemically induced;
Low Back Pain;
drug therapy;
Pain, Intractable;
drug therapy;
Substance-Related Disorders;
prevention & control
- From:Annals of the Academy of Medicine, Singapore
2009;38(11):960-966
- CountrySingapore
- Language:English
-
Abstract:
The use of opioids for the treatment of chronic non-cancer pain has become more widespread recently. Available data support the short-term use of opioids in clearly defined nociceptive and neuropathic pain states. Their use in 'pathological' pain states without a clear diagnosis, such as chronic low back pain, is more contentious. A decision to initiate opioid treatment in these conditions requires careful consideration of benefits and risks; the latter include not only commonly considered adverse effects such as constipation, but also opioid-induced hyperalgesia, abuse, addiction and diversion. Ideally, treatment goals should not only be relief of pain, but also improvement of function. Opioid treatment of chronic non-cancer pain requires informed consent by, and preferably a treatment contract with, the patient. Treatment should be initiated by a trial period with defined endpoints using slow-release or transdermal opioids. Ongoing management of the patient requires ideally a multi-disciplinary setting. Treatment should not be regarded as life-long and can be discontinued by tapering the dose.
