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Perspectives

Use of opioids in chronic noncancer pain

Stephan A Schug, Mir Wais Sekandarzad

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An updated version is available in the linked supplement

Abstract

Opioids play a much smaller role in the management of chronic noncancer pain than they do in that of severe acute pain and cancer pain. They are beneficial in a small subset of patients with chronic noncancer pain but there are pharmacological, psychological and societal concerns about their current widespread use for this indication.

Key Points

  • There are pharmacological, psychological and societal concerns about the current widespread use of opioids for chronic noncancer pain.
  • Opioids should not be regarded as the sole approach to managing chronic noncancer pain but as one component of a multidisciplinary management plan.
  • They should only be used for this type of pain after an initial trial with defined positive outcomes, in particular improvement of function.
  • They are not intended as life-long treatment and should be discontinued by tapering the dose when treatment goals are reached (or aberrant drug-taking behaviour becomes obvious).

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