Opioids for managing chronic non-malignant pain: safe and effective prescribing.

Kahan M, Srivastava A, Wilson L, Mailis-Gagnon A, Midmer D.
Addiction Medical Service, St Joseph’s Health Centre, Toronto, Ontario, Canada. kahanm@stjoe.on.ca

OBJECTIVE: To review the evidence on safe and effective prescribing of opioids for chronic non-malignant pain.

QUALITY OF EVIDENCE: MEDLINE was searched using the terms “opioid effectiveness” and “adverse effects.” There is strong evidence that opioids are effective for both nociceptive and neuropathic pain, but limited evidence that they are effective for pain disorder. There is little information on their effectiveness at high doses or on the adverse effects of high doses.

MAIN MESSAGE: Opioids should be initiated after an adequate trial of acetaminophen or nonsteroidal anti-inflammatory drugs for nociceptive pain and of tricyclic antidepressants or anticonvulsants for neuropathic pain. Patients should be asked to sign treatment agreements and to give informed consent to treatment. Patients should experience a graded analgesic response with each dose increase. Titrate doses of immediate-release opioids slowly upward until pain reduction is achieved, and then switch patients to controlled-release opioids. Most patients with chronic non-malignant pain can be managed with<300 mg/d of morphine (or equivalent).

CONCLUSION: Opioids are safe and effective for managing chronic pain.

PMID: 17279219 [PubMed – indexed for MEDLINE]

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Folllowing Rick Usher's death in December 2008, at his request in September of that year, I had agreed, as his principal contributor and an experienced journalist, to run the FMS Global News service due to his heavy commitments to music and raising research funds through this avenue. Following his sad and sudden death I hope to continue his work as he would have wished.
This entry was posted in Analgesics, Boston, Britain, CFS, Chronic Fatigue Syndrome, Chronic Pain, Chronic Pain Disorders, Chronic Widespread Pain, Clinical Pain, Denmark, Diseases, Drugs, Dysfunctional Pain Processing, Dysfunctional Pain Syndrome, Europe, Feeds, Fibrohugs, Fibrohugs News, Fibromyalgia, Fibromyalgia Blogs, Fibromyalgia News, Fibromyalgia News Belgium, Fibromyalgia News Denmark, Fibromyalgia News Deutschland, Fibromyalgia News France, Fibromyalgia News Israel, Fibromyalgia News Italy, Fibromyalgia News Japan, Fibromyalgia News Jerusalem, Fibromyalgia News Korea, Fibromyalgia News Southeast Asia, Fibromyalgia News Turkey, Fibromyalgia News Wisconsin, Fibromyalia News Germany, Finland, FMS, FMS Global News, FSS, Functional Somatic Syndrome, Global News, Health, Health Canada, Invisible Illnesses, Italy, Japan, Low Back Pain, Medical, Medical Journals, Medical Research, Montreal, Myofacial Pain Syndrome, Narcotics, News, News Australia, News Belgium, News Canada, News Denmark, News France, News India, News Ireland, News Israel, News Italy, News Japan, News Jerusalem, News Korea, News Montreal, News Nigeria, News Norway, News Quebec, News Saskatchewan, News Scotland, News Southeast Asia, News Spain, News Sweden, News Toronto, News Turkey, News UK, News Wisconsin, NIH, Ontario, Ottawa, Ottawa City Feed, Oxford, Pain, Pain Management, Pain Management Clinic, Pain Matrix, Pharmacological, Philadelphia, Physiology, Primary Fibromyalgia Syndrome, Quality of Life, Quebec, Research, RLS, RSS, Seattle, Somatic Pain, Spain, Stockholm, Surrey and Sussex, Swedish, Switzerland, Syndromes, Tenderpoints, The Netherlands., Toronto, Toronto City Feed, US, USA, Virginia, Washington D.C. City Feed, Washington DC, World News. Bookmark the permalink.

2 Responses to Opioids for managing chronic non-malignant pain: safe and effective prescribing.

  1. Pingback: Acetaminophen » Blog Archive » Thera P - What is the Prevalence of sinusitis?

  2. Pingback: Acetaminophen » Blog Archive » Opioids for managing chronic non-malignant pain: safe and effective prescribing.

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