Who Should Receive Opioid Therapy?
Opioids are prescribed for visceral, nociceptive and neuropathic pain, or a combination of pain types. They are the mainstay of treatment for acute pain caused by injury or surgery and are universally employed against cancer pain, but their long-term use for arthritis, back and neck pain, Complex Regional Pain Syndrome, fibromyalgia, and other sources of chronic, nonmalignant pain remains controversial. Some patients with persistent moderate-to-severe nonmalignant pain achieve acceptable analgesia with opioid therapy while exhibiting few or manageable adverse effects or aberrant drug-related behaviors.19 Other patients experience inadequate analgesia or side effects that cannot be tolerated with opioids.12, 20 Part of the therapeutic success achieved with the use of a prescribed opioid is determined by patient characteristics such as predisposition to opioid side effects, psychological distress, and history of drug use.16 More long-term success has been reported in patients who are sta
