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Feature Article

The judicious use of opioids in managing chronic noncancer pain

Milton L Cohen, Alex D Wodak

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Abstract

The aim of drug therapy in patients with chronic noncancer pain is mainly symptom control. Opioids have a place in the treatment of some patients as part of a biopsychosocial framework that does not rely on pharmacotherapy alone.

Key Points

  • Symptom control in the patient with chronic pain is an important aim of treatment, as part of a multimodal approach and as a passport to improved quality of life.
  • Consider the use of opioids for managing chronic pain when non-opioid drugs have been found to be ineffective or not tolerated.
  • Before prescribing opioids, assess psychological status, history of substance abuse and social context.
  • Opioid treatment is an ongoing trial of therapy: response to opioids and problems with opioids are difficult to predict.
  • Regularly assess the six As: analgesia, activity, adverse effects, affect, aberrant behaviours and accurate records.
  • Seek advice if an apparent increase in opioid requirement is occurring.

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