Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related polices.
Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.
Opiates are dangerous to abuse, and those who care to can easily measure the body count associated with the new era of pain control (4). Once again, it’s not small…. and it’s far more the direct product of these campaigns than their architects are willing to admit *. To be fair, it is certain that human nature, human biology, and human avarice are the most important drivers of this problem; these initiatives simply made it worse. Dare I say that while no one ever died of pain, lots of people have died (in the past few years) from its treatment? Or at least in part as a consequence of these initiatives?
"There are sensible ways to prescribe opioids for chronic pain that minimize the chance of addiction and increase the chance that addiction will be noticed if it occurs. For starters, the sustained release opioids that I use for chronic pain are less likely to produce the euphoria that is often a basic feature of narcotic abuse.
Opioids for chronic pain are time-release or long-acting drugs that are taken in pill or patch form (not injected) so they slip into the bloodstream gradually, without large peaks and valleys. Therefore, the same rush or high that comes when short-acting drugs speed to the brain does not happen.
When a person receives pain relief medicine in steady doses, the pain is not completely abolished but diminished enough so they can return to normal activities. Instead of euphoria or addiction, pain slides from unbearable to bearable, freeing an individual to rejoin their family, return to work, do favorite activities, and enjoy being alive.
All pain relievers for chronic pain (including opioids), are intended to mute pain enough to help a person function better; they usually do not eliminate it altogether."
Scott Fishman, M.D., is a leading expert in pain management.