Opioids for the Treatment of Chronic Noncancer Pain

• Published in: The American journal of medicine Vol. 125; no. 12; pp. 1155 - 1161
• Main Author: Warner, Elizabeth A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier; Elsevier Sequoia S.A
• Subjects: Algorithms; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Chronic Disease; Chronic illnesses; Chronic pain; Drug and Narcotic Control; General aspects; Humans; Internal Medicine; Medical sciences; Narcotics; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - prevention & control; Opioids; Pain; Pain - drug therapy; Pain - epidemiology; Pain management; Practice Guidelines as Topic; Prescription Drug Misuse; Risk Assessment; Risk Factors; Side effects; Substance Abuse Detection; Treatment agreements; Urinalysis; Urine drug testing; Urine drug testing; Treatment agreements; Chronic pain; Opioids; Medicine; Chronic; Pain; Treatment
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2012.04.032

Abstract Increasingly, opioids are used to treat chronic noncancer pain. While opioids are well recognized for their effectiveness in treating acute pain, the evidence supporting the benefits for the treatment of chronic pain is less well established. Improvement of both pain and function should be considered goals of therapy. Patients with chronic pain have a higher incidence of preexisting psychological disorders. Adverse effects of opioid therapy include dependence, overdose, and withdrawal. Risk factors for poor outcomes with opioid therapy are identified, and include preexisting mental illness and dose prescribed. Recommended strategies to more safely use opioids are discussed, including tools for identifying high-risk patients. The evidence supporting the use of treatment agreements and urine drug testing to reduce the effects of adverse outcomes is limited.