Current Recommendations Vary

Current guideline recommendations on using opioids to treat chronic pain vary. However, most guidelines, including the ones from the American Pain Society in conjunction with The American Academy of Pain Medicine, recommend that nondrug options should be the first line of treatment along with nonopioid pain medications. In addition, when opioids are prescribed, physicians should limit the dose and duration of use.2

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To avoid diversion, Turner recommended that patients complete an opioid agreement with their physician. In addition, a high daily dose of opioids should be avoided if possible. When it exceeds a morphine equivalent dose of 100 to 120 mg, primary care clinicians need to refer patients to a pain specialist. Guidelines currently aim to reduce high-dose opioid prescribing to minimize risks.

Complications Tied to Long-Term Opioid Use?

Opioids to treat chronic pain have been associated with some long-term health complications, and even death, according to a recent study published in PAIN by Ekholm and colleagues. The study found that chronic pain patients in Denmark who were treated with opioids had higher mortality and higher hospital admission rates than those who were not treated with opioids.1

However, Harald Breivik, MD, of Oslo University Hospital in Norway, noted in a commentary that the study published by Ekholm and colleagues has some limitations. Specifically, the data are not convincing because it is not clear whether the opioid-treated patients actually had more serious, more severe pain before they were started on opioids than chronic pain patients who did not have opioid treatment.  

It is hard to determine whether the opioid treatment had a specific effect on increased all cause mortality.2 Although the results are interesting, Breivik cites the need for long-term follow-up studies of chronic pain patients randomized to opioid treatment versus control treatment.