Chronic opioid therapy in nonmalignant pain

Area of Science:

• Pain Medicine
• Pharmacology
• Addiction Psychiatry

Background:

• Chronic opioid therapy is increasingly used for nonmalignant pain.
• Concerns exist regarding efficacy, toxicity, and addiction potential.
• Distinguishing medical use from substance abuse is complex.

Purpose of the Study:

• To critically examine the use of chronic opioid therapy in nonmalignant pain.
• To review evidence from cancer pain, nonmalignant pain, and addict populations.
• To clarify issues surrounding opioid therapy for chronic nonmalignant pain.

Main Methods:

• Literature review synthesizing data from diverse patient populations.
• Critical analysis of major issues in chronic opioid therapy for nonmalignant pain.
• Examination of evidence regarding analgesia, toxicity, and addiction.

Main Results:

• A select subpopulation of patients may achieve sustained partial analgesia.
• This may occur without significant toxicity or addiction characteristics.
• Evidence suggests careful patient selection is paramount.

Conclusions:

• Chronic opioid therapy can be beneficial for a subset of patients with nonmalignant pain.
• Clear definitions of addiction and medical considerations are needed.
• Active clinician participation in discussions is vital to inform patient care decisions.