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Mar 12, 2012

What Are We Treating With Long-term Opioid Therapy?

Author Affiliations

Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Dr Sullivan) and Anesthesiology and Pain Medicine (Dr Ballantyne), University of Washington, School of Medicine, Seattle.

Arch Intern Med. 2012;172(5):433-434. doi:10.1001/archinternmed.2011.2156

At present, we see widespread use of long-term opioid therapy (LtOT) for chronic noncancer pain based on the moral argument that this type of pain causes as much suffering and deserves treatment as much as cancer pain, as well as on the “scientific” argument that enduring analgesia can be achieved at stable doses with minimal risk of addiction.1 While modest reductions (approximately 30%) in pain have been reported during the 3-month duration of most trials, other prospective studies suggest that LtOT (>3 months) may not provide sustained analgesia or improve role function in a clear majority of patients.2 Some nonrandomized prospective studies suggest that opioid treatment may actually retard functional recovery.3,4