ABSTRACT
Pain is the most common reason that persons enter the health care system and over 50 million Americans report chronic pain annually.1 There are an estimated 25 million doctor visits for low back pain alone. Approximately 45 percent of Americans seek medical care for a painful condition at some time in their lives.2 Opioids remain the most effective medications for moderate to severe acute pain and cancer pain, and the usefulness of these drugs as well as the importance of using them when medically indicated is increasingly recognized in chronic nonmalignant pain (CNMP) management.3,4 Major erosion of quality of life and an estimated $80 billion in lost productivity are attributed to CNMP annually in the United States and it is probable that more aggressive analgesic pharmacotherapy could decrease the huge impact that CNMP has on American society.2 However, many clinicians hesitate to prescribe opioids and many patients fear taking them due to adverse effects. One of the most common and troublesome of these effects is opioid-induced constipation.
