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A Practical Guide for the Use of Opioids in Chronic Pain

 Despite the availability of mono-graphs, papers, lectures, and web sites to teach about opioids—and the fact that the American Geriatrics Society has written that opioids are safer than NSAIDs for geriatric patients1— the majority of primary care clinicians are uncomfortable prescribing them for chronic pain because they:

  1. don’t understand the difference between physical dependence and addiction and assume that they will turn their patients into addicts;
  2. believe that appropriate patients for opioid analgesia are only those whose chronic pain has a cause that can be seen on imaging studies;
  3. believe they will have to endlessly increase the opioid dose as their patients develop tolerance to the pain-relieving effects of opioids;
  4. are afraid of being scammed and assume that most patients want drugs for their mood-altering effects;
  5. assume that patients who are on opioids would be constantly phoning for refills on evenings and weekends;
  6. believe that once a patient is put on opioids, it’s very difficult to wean them off;
  7. tend to use only short-acting opioids (if they use opioids at all) and do not understand the benefits of prescribing sustained-release drugs for chronic pain;
  8. have heard that urine drug tests are a good idea but don’t understand when, and how, to order them or how to interpret the results;
  9. are unfamiliar with opioid risk tools that can help them decide which patients are less, or more, likely to abuse prescription drugs;
  10. need instruction in efficient record keeping so as to be able to keep track of what they have prescribed and when the next refill is due; and
  11. need a framework for the appropriate elements of a follow-up visit.

The goals of this paper are to debunk the mistaken beliefs about opioid prescribing for chronic pain (items 1-6); to educate clinicians on the basic features of opioids (item 7); and to describe office procedures and tools that will make them more willing to consider using opioids for selected legitimate pain patients (items 8-11).

Please refer to the Nov/Dec 2009 issue for the complete text. In the event you need to order a back issue, please click here.

Last updated on: February 21, 2011
First published on: November 1, 2009