LONG-TERM TREATMENT OF CHRONIC NONCANCER PAIN WITH ORAL OPIOIDS

The treatment of cancer pain with opioids is well accepted. However, t he use of opioids for the treatment of non-cancer pain is still a matt er of controversy. The main matters of concern are physical dependence and opioid abuse. Another argument against opioids is the lack of eff icacy. Experiences with opioids in non-cancer pain have been published on about 850 patients, the longest therapy lasting almost 14 years. 8 5% of the patients treated with opioids had beneficial effects. In a n umber of investigations evaluating the opioid sensibility of pain by P CA and intravenous infusions, 67-80% of the patients with neuropathic pain responded to opioids. The efficacy of opioids in the treatment of non-cancer pain was proven in 3 placebo controlled studies. In 2 stud ies pain reduction in neuropathic pain was similar to that in nocicept ive pain. When opioids are used, the administration has to be performe d according to well defined standards. The indication for opioids must be made by a specialist in pain management. The diagnosis must clearl y reveal an organic origin of the pain. Before the start of therapy th e duration as well as the criteria for discontinuation must be set up. The treatment must be controlled by a specialist team and frequent re gular follow up investigations must be performed. These must include p roper documentation of the pain level, changes in patients' function a nd in serial activities. The reliable intake of prescribed medication must be assured if necessary by laboratory screening. The treatment of non-cancer pain with opioids may be an alternative for these patients , who didn't gain sufficient reduction of pain by other therapies. Sta ndards for this therapy are an absolute necessity and are to be follow ed closely.