The role of opioids in managing chronic non-cancer pain

The use of opioids for the treatment of chronic non-cancer pain has become more widespreadrecently. Available data support the short-term use of opioids in clearly defi ned nociceptive andneuropathic pain states. Their use in ‘pathological’ pain states without a clear diagnosis, suchas chronic low back pain, is more contentious. A decision to initiate opioid treatment in theseconditions requires careful consideration of benefi ts and risks; the latter include not only commonlyconsidered adverse effects such as constipation, but also opioid-induced hyperalgesia,abuse, addiction and diversion. Ideally, treatment goals should not only be relief of pain, butalso improvement of function. Opioid treatment of chronic non-cancer pain requires informedconsent by, and preferably a treatment contract with, the patient. Treatment should be initiatedby a trial period with defi ned endpoints using slow-release or transdermal opioids. Ongoingmanagement of the patient requires ideally a multi-disciplinary setting. Treatment should notbe regarded as life-long and can be discontinued by tapering the dose.