Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids

Physicians involved in cancer pain management treat thousands of patients w ith opioids, whose effective analgesia improves overall functioning. Side e ffects generally are tolerable, and treatment can be maintained with stable doses for long periods. Problems with addiction are infrequent. Many physi cians, however, assume that opioids should be used only for chronic maligna nt pain. Research and clinical experience have demonstrated that opioids ca n safely and effectively relieve most chronic moderate to severe nonmaligna nt pain. Fears of addiction, disciplinary action, and adverse effects resul t in ineffective pain management. With current information on the use of op ioids in chronic nonmalignant pain, primary care physicians can overcome th ese obstacles. Guidelines must clearly define the role of the primary care physician in the proper management of pain and the integration of opoiod th erapy. Used appropriately, opioids may represent the only source of relief for many patients.