Short Communication - Journal of Pain Management and Therapy (2023) Volume 7, Issue 4
A brief note on opioid therapy for chronic non-malignant pain.
Department of Neurology, University of California-San Francisco, Horton Street, Emeryville, USA
- *Corresponding Author:
- Maria Iddilia
Department of Neurology
University of California-San Francisco, Horton Street
Received:03-Jul-2023,Manuscript No. AAPMT-23-106610; Editor assigned: 05-Jul-2023, PreQC No. AAPMT-23-106610(PQ); Reviewed:19-Jul-2023, QC No. AAPMT-23-106610; Revised:24-Jul-2023, Manuscript No. AAPMT-23-106610(R); Published:31-Jul-2023, DOI: 10.35841/aapmt-7.4.160
Citation: Iddilia M. A brief note on opioid therapy for chronic non-malignant pain. J Pain Manage Ther. 2023;7(4):160
Chronic non-malignant pain affects millions of individuals worldwide, impacting their physical, emotional, and social well-being. For many years, opioids have been widely prescribed to manage chronic pain due to their potent pain-relieving properties. However, the use of opioids for chronic non-malignant pain is a topic of ongoing debate and scrutiny due to the potential risks associated with long-term opioid therapy. This article aims to explore the use of opioid therapy for chronic non-malignant pain, discussing its benefits, risks, and the importance of a balanced approach to pain management.
Chronic non-malignant pain
Chronic non-malignant pain encompasses a wide range of conditions, including musculoskeletal disorders, neuropathic pain, and fibromyalgia. Unlike acute pain, which serves as a warning signal of injury or illness, chronic pain persists beyond the expected healing period and can last for months or even years. The impact of chronic pain extends beyond physical discomfort, often leading to emotional distress, impaired function, and diminished quality of life.
Role of opioids in pain management
Opioids are a class of drugs that interact with opioid receptors in the brain and spinal cord, reducing the perception of pain and altering emotional responses to pain. They are valuable tools in managing acute pain and pain related to cancer and end-of-life care. In cases of chronic non-malignant pain, opioid therapy may be considered when other treatments have been ineffective or are not feasible.
Benefits of opioid therapy for chronic non-malignant pain
Pain relief: Opioids can provide effective pain relief, especially for severe pain that is unresponsive to other treatments. They can improve an individual's ability to function and engage in daily activities.
Improved quality of life: When used appropriately, opioids can enhance the quality of life for patients living with chronic pain by reducing pain intensity and associated distress.
Increased functionality: By alleviating pain, opioids may enable individuals to participate in physical therapy and rehabilitation, improving their functional abilities.
Management of breakthrough pain: Opioids can be helpful in managing breakthrough pain, which refers to sudden and intense pain that occurs despite ongoing pain management.
Palliative care: For individuals with advanced chronic illnesses, such as late-stage heart failure or chronic obstructive pulmonary disease (COPD), opioids can offer palliative care, improving comfort and reducing suffering.
Risks and challenges of opioid therapy
While opioids can provide significant pain relief, they also pose several risks, especially when used for chronic non-malignant pain over an extended period. Some of the challenges and potential risks associated with opioid therapy include:
Tolerance and dependence: Long-term use of opioids can lead to tolerance, requiring higher doses to achieve the same pain relief. Additionally, some individuals may develop physical dependence on opioids, leading to withdrawal symptoms if the medication is abruptly discontinued.
Opioid Use Disorder (OUD): Prolonged opioid use can lead to the development of OUD, characterized by compulsive drug-seeking behavior and impaired control over opioid use.
Side effects: Opioids can cause a range of side effects, including drowsiness, constipation, nausea, vomiting, and respiratory depression.
Sedation and cognitive impairment: Opioids can cause sedation and cognitive impairment, affecting an individual's ability to perform daily activities and work.
Risk of overdose: Opioid overdose is a significant concern, particularly when higher doses are used or when opioids are combined with other central nervous system depressants.
Interactions with other medications: Opioids may interact with other medications, such as benzodiazepines and antidepressants, increasing the risk of adverse effects and respiratory depression.
Psychological impact: Prolonged opioid use can lead to changes in mood and behavior, exacerbating mental health conditions or contributing to the development of depression or anxiety.
Opioid-Induced Hyperalgesia (OIH): In some cases, long-term opioid use can paradoxically increase pain sensitivity, leading to a condition known as OIH.
Minimizing risks and ensuring safe use of opioids
Individualized treatment plans: Each patient's pain condition and response to opioids are unique. An individualized treatment plan should be developed in collaboration with the patient, taking into account their medical history, pain intensity, and goals of therapy.
Regular reassessment: Patients on opioid therapy require regular reassessment of their pain levels, functionality, and any potential side effects. Opioids should be tapered or discontinued if they are no longer providing adequate pain relief or if the risks outweigh the benefits.
Prescription Monitoring Programs (PMPs): Healthcare providers should use prescription monitoring programs to track patients' opioid use and identify potential cases of misuse or diversion.
Risk stratification: Prior to initiating opioid therapy, healthcare providers should assess patients for risk factors associated with opioid misuse, including a history of substance abuse, mental health disorders, or a family history of addiction.
Education and informed consent: Patients prescribed opioids should receive comprehensive education about the risks and benefits of opioid therapy. Informed consent should be obtained, and patients should be made aware of the potential for side effects, tolerance, and dependence.
Multidisciplinary approach: Opioid therapy should be part of a multidisciplinary pain management approach, incorporating non-opioid pharmacological treatments, physical therapy, psychological interventions, and other modalities.
Avoiding high doses and long-term use: Whenever possible, opioids should be prescribed at the lowest effective dose and for the shortest duration necessary to manage pain effectively.
Opioid therapy can be an essential tool in managing chronic non-malignant pain for some patients. However, the potential risks associated with long-term opioid use require careful consideration. Balancing the benefits and risks of opioid therapy is crucial in ensuring safe and effective pain management. Healthcare providers should follow evidence-based guidelines, regularly reassess patients, and incorporate a comprehensive approach to pain management, minimizing the risks of opioid-related adverse events while optimizing pain relief and improving the overall well-being of patients living with chronic non-malignant pain.
- Sullivan MD, Howe CQ.Opioid therapy for chronic pain in the United States: Promises and perils.PAIN. 2013;154:S94-100.
- Hedger MP, Meinhardt A.Cytokines and the immune-testicular axis.J Reprod Immunol. 2003;58(1):1-26.
- Winkelstein BA, DeLeo JA.Nerve root injury severity differentially modulates spinal glial activation in a rat lumbar radiculopathy model: Considerations for persistent pain.Brain Res. 2002;956(2):294-301.
- Fredheim OM, Skurtveit S, Breivik H, et al.Increasing use of opioids from 2004 to 2007-pharmacoepidemiological data from a complete national prescription database in Norway.Eur J Pain. 2010;14(3):289-94.
- Ruscitto A, Smith BH, Guthrie B.Changes in opioid and other analgesic use 1995-2010: Repeated cross?sectional analysis of dispensed prescribing for a large geographical population in S cotland.Eur J Pain. 2015;19(1):59-66.