Opiate Treatment for Patients in Chronic Non-Cancer Pain

摘要

To the Editor: I disagree with the global condemnation of the use of chronic high-dosage opiates for treating pain patients expressed by Jon Streltzer, M.D., and Luther Johansen, M.D., in the April 2006 issue of the Journal (1). In their clinical case conference about an addicted woman with a pain syndrome, Drs. Streltzer and Johansen argue that there is too much careless prescribing of opiates by well meaning physicians. They maintain that such careless prescribing is fostered by a cultural belief system in the efficacy of opiates for treating chronic pain, a belief that is unsupported by solid evidence. I feel that this is an oversimplification of a complicated and tragic problem. Drs. Streltzer and Johansen Reply To the Editor: The case we presented illustrates how non-evidence-based medical attitudes influenced opioid use in a chronic pain patient (1). In our experience, our study case is far from unique and, with increasing frequency, similar cases are being referred to psychiatrists after opioid dependence has been established. In our discussion, we reviewed the current evidence suggesting that chronic intake of high-dose opioids is neither effective nor safe in the treatment of , persistent pain and that it likely enhances pain sensitivity in general.