Opioids for chronic pain: promise and pitfalls

The prescribing of opioid medicines is increasing progressively despite a substantial body of literature identifying potential limitations and harms of therapy. Production and dissemination of best practice guidance in relation to prescribing do not yet seem to have an impact on this trend. This article highlights updated concerns about and unanswered questions in relation to opioid treatment to provide focus for further scrutiny and evaluation of opioid treatment for pain.

The literature cited in this paper confirms that opioid prescribing is prevalent despite an established evidence base spanning a decade that indicates that efficacy of opioids in long-term pain management remains uncertain and that harms of therapy are well defined. In particular, problems with treatment are more likely to occur when high doses are used and in certain patient populations and many recent high-quality studies highlight these problems. Although much is to be learned regarding clinical decision making, it is clear that current prescribing activity does not reflect the existing knowledge base.

Authors are unanimously agreed that the literature answers some important questions about opioid therapy but there are substantial knowledge gaps, particularly in relation to benefits and harms of long-term therapy in day-to-day clinical practice. Evidence-derived guidance clearly identifies common and important pitfalls in relation to opioid use but promotion of adherence to guidance remains a substantial challenge.