Since all drugs have adverse effects, the decision to prescribe always involves a weighing of benefits and risks. In the case of opioids prescribed for chronic pain (excluding life-threatening conditions such as cancer), we have no evidence of benefit with long-term use and much evidence of harm. However, “no evidence of benefit” is not the same as “evidence of no benefit,” especially when the patient in front of you has chronic pain and has tried nonopioid medications (eg, acetaminophen, ibuprofen) without relief or has been taking a stable dose of opioids for months or years and is asking you for a prescription.
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Katz MH. Opioid Prescribing for Chronic Pain: Not for the Faint of Heart. JAMA Intern Med. 2016;176(5):599–601. doi:10.1001/jamainternmed.2016.0664
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