Chronic opioids: a reassessment

Opioids have long been associated with addiction and antisocial behavior. Yet recent experience and studies raise questions about the prohibition of chronic opioids in nonmalignant pain. From a purely pharmacologic point of view, opioids have perhaps the best side effect profile in our armamentarium. Studies suggest addiction is not as dependent on the nature of the drug as it is on the particular patient, some patients being highly addictable while the majority are not. Successful use of opioids for chronic nonmalignant pain depends on using them only when other measures have failed, when psychosocial and other addiction risk factors are clearly identified, and when guidelines and documentation are meticulous. Then opioids can often be used successfully to achieve good pain relief without undue risk of addiction or other side effects. The endpoint for opioid use is not the absolute dose of medications but rather the balance between benefits and side effects.