Opioids and chronic pain: using what we know to change what we do

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Abstract

Purpose of review

The review draws together firm conclusions about effectiveness and harms of prolonged opioid treatment and explores the complex nature of chronic pain.

Recent findings

The literature may now explain why long-term opioid treatment has failed to live up to its late 20th century promise. An understanding of sources of bias in clinical trials has allowed a more detailed and accurate picture of the role of opioids in chronic pain to emerge and there is recognition that populations in clinical trials differ in very important ways to those given opioids in clinical practice. The prevalence of psychiatric and emotional comorbidities in patients with long-term pain is identified in clinical populations and the influence of these on the experience of pain and the outcomes of therapy are well described. This improved understanding of the role of opioids and the complexity of the pain experience should allow more appropriate assessment of patients and better focused treatment planning, but the influences on prescriber behaviour are many and varied and change in prescribing practice may be difficult to achieve.

Summary

Clinicians treating patients with chronic pain need to understand the many contributors to the reported experience of pain. A shared understanding of this complexity helps to set prescriber and patient expectations appropriately. If medications are used as part of the treatment plan they should only be prescribed if they produce useful pain relief and meaningful improvements in quality of life.

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