ABSTRACT
Chronic opioid therapy is the main therapeutic approach for moderate to severe cancer-related pain. Eighty-seven percent of physician members of the American Pain Society maintain patients with noncancer pain on opioids and support the long-term use of opioids for patients with chronic noncancer pain. Chronic opioid therapy may allow the return of normal function without significant adverse side effects in those who have failed other treatments. Opioids are the first-line therapy for moderate to severe pain in nociceptive, neuropathic, and mixed pain syndromes associated with terminal illness. Regardless of the underlying pathophysiology of the pain, opioids are effective. A double-blinded, placebo-controlled study of 104 patients experiencing moderate to severe osteoarthritis pain using controlled-release oxycodone demonstrated significant reduction in reported pain, improvement in coping, reduction in helplessness, and passive coping. Use of mutually agreed upon plans of care with defined points of evaluation prospectively developed do remove much of the emotion associated with long-term opioid prescribing for chronic pain.
