Strong opioids for chronic non-cancer pain

A challenging situation: A number of patients experiencing chronic noncance r pain are unsatisfied with standard treatment modalities. This raises the question of whether there may be a place for strong opioids in the manageme nt of these patients. Randomised placebo-controlled trials of strong opioid s generated rather disappointing results in this type of pain. Observationa l studies have indicated that strong opioids may improve comfort and functi on in some patients with intractable nociceptive or neuropathic pain. Howev er, opioids may be ineffective in others and intolerable side effects, heig htened pain and functional impairment as well as drug addiction may also oc cur. A promising solution: Finally, strong opioids do not appear to be the issue to ail intractable chronic nonmalignant pain states, but they may be a pos sible issue to a subset of selected and informed patients who agree on the goals of the treatment and accept regular monitoring.