opioids for chronic pain …

June 30, 2011

in Hospice & Palliative Medicine,Journal Club

… Grady et. al. provide an excellent summary of the case for not using opiates for chronic non-malignant pain …

“A partial explanation of why we got to this point is that the lessons learned from the undertreatment of pain in patients with cancer were generalized to patients with chronic pain and no clear end point of cure or death … Astonishingly, little is known regarding the long-term efficacy of opioid therapy for chronic pain.”

“We believe that the trend during the past decade to prescribe more opioids for more patients with chronic pain should be reversed. Health care professionals first should try to treat the underlying condition and to use effective nondrug treatments such as physical therapy, cognitive behavioral therapy, pain management techniques, and appropriate assistive devices. First-line drug therapy for chronic pain should include aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and appropriate corticosteroid injections. Because 30% to50% of patients with chronic pain also experience depression and anxiety, health care professionals should screen for these conditions. Treatment of these comorbidities, once they are identified, should be an important part of a patient’s treatment plan. In 1 study, treatment of depression resulted in a 30% reduction in pain scores, approximately the same average effect as treatment with opioids.”



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