Chronic opioid treatment of intractable, non-malignant pain

There is a sub-group of patients with non-malignant medical conditions who have severe, intractable pain and who require chronic opioid administration for adequate pain control. Reported here is a systematic clinical evaluation of 52 such patients who were referred after they had failed numerous, non-opioid pain treatments. Major causes of pain were irreversible degenerative and/or traumatic injuries to the musculoskeletal system. A variety of opioids in high daily dosages were required to achieve adequate pain control in these patients. Once pain relief was achieved, patients did not escalate their dosage, and they were able to maintain pain relief for long time periods. Although opioids produced dependence in all patients and complications of constipation and edema in about one third, high daily opioid dosage treatment appeared to be the only medical means to achieve adequate pain control in these subjects. We conclude that opioid maintenance should be utilized as a last resort treatment in patients who fail other pain treatments.