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Perspectives

Chronic noncancer pain: the challenge of implementing opioid guidelines

Chris Hayes

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Abstract

Guidelines suggest that opioids may be trialled in patients with chronic noncancer pain if expected benefits outweigh the risks. This article addresses how this guidance should be interpreted given the lack of evidence of efficacy and the clear evidence of harm from long-term opioid use.

Key Points

  • An opioid cessation plan should be made whenever opioids are prescribed for patients with acute pain.
  • Opioids are no longer considered a core component of treatment of patients with chronic noncancer pain (CNCP). If considering opioid initiation in this setting, discussion with a relevant specialist is recommended.
  • A conversation about opioid deprescribing can be initiated with any patient taking opioid maintenance treatment for CNCP.
  • Patients can be involved in the deprescribing plan with decisions on whether to undertake a monthly or weekly step down off opioid medications.
  • Optimal treatment of CNCP involves supported transition from passively-received treatments such as medications or medical procedures to active self-management.

    Picture credit: © Chromorange/Biderbox/Diomedia.com

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