Safe and effective long-term opioid therapy for chronic noncancer pain
requires clinical skills and knowledge in opioid prescribing and assessing
and managing risks associated with opioid abuse, addiction, and diversion.
The American Pain Society and the American Academy of Pain Medicine
commissioned a review of the research on the efficacy of using opioids
for chronic noncancer pain and assembled a multidisciplinary expert
panel to make recommendations.
Although evidence is limited, the expert panel concluded that long-term
opioid treatment can be effective for carefully selected and monitored
patients with chronic noncancer pain. However, opioids are also associated
with potential harms. The recommendations provide guidance on selecting
patients and managing risk; starting and titrating opioids; prescribing
methadone for pain; monitoring patients on long-term opioid therapy;
managing breakthrough pain; using high doses of opioids, transitioning
patients from one opioid to another; discontinuing opioid therapy; preventing
and managing adverse effects; driving and working safety; long-term
opioids in pregnancy; and other opioid-related issues. Chou R, Fanciullo
GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain
DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG,
Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH,
Miaskowski C. Adapted from J Pain. 2009 Feb;10(2):113-30.
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PMID: 19187889
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