ABSTRACT
The mean decrease in pain intensity for opioids in chronic noncancer pain (CNCP) is approximately 30 percent. Patients who develop problems with opioid therapy, particularly those with dependency/addictive behavior traits, are timeconsuming and frustrating to manage, their manipulative behavior stressing even the most tolerant staff. The mean reduction in pain intensity with opioids was approximately 30 percent for both nociceptive and neuropathic pain. Only two randomized controlled trials directly compared long-acting opioids in a head-to-head fashion. Most patients with CNCP are treated with long-acting opioids rather than short-acting preparations, in the belief that steady plasma levels are associated with better pain control and fewer adverse effects, including withdrawal or dependency. Opioid toxicity is a potentially serious problem and may be particularly so in the chronic noncancer pain population. Tramadol is a unique opioid analgesic combining mu, noradrenergic, and serotonergic receptor agonist effects.
