Understand appropriate long-term use of opioids-seventeen years and counting.

摘要

Controversy continues among pain practitioners concerning the use of opioids for the treatment of chronic noncancer pain. This controversy is not new. Similar concerns and issues were voiced in the early 1990s. However, by the mid-1990s, professional and grass root efforts to promote improved palliative care and cancer pain control generalized to the noncancer pain arena and dampened the debate of these issues. More recently they have resurfaced, reinvigorated in part by popular press reports of opioid medication abuse and alleged practitioner misconduct.Much of this controversy stems from the limited evidence regarding the long-term benefits and hazards associated with daily opioid analgesic use. Seventeen years have passed since Turk and Brody identified some key research questions that might reduce or resolve concerns surrounding chronic opioid therapy. Yet, amazingly there remains a paucity of data regarding long-term opioid efficacy. In the absence of these data, providers must rely on whatever information is available to inform their clinical judgment, a situation unchanged from what was true in 1991.