PHARMACIST STEVE

Nadeau_Neurology 2015   <— click here to read

ABSTRACT

The recent American Academy of Neurology position paper by Franklin, “Opioids for chronic
noncancer pain,” suggests that the benefits of opioid treatment are very likely to be substantially
outweighed by the risks and recommends avoidance of doses above 80–120 mg/day morphine
equivalent. However, close reading of the primary literature supports a different conclusion:
opioids have been shown in randomized controlled trials (RCTs) to be highly effective in the
treatment of chronic nonmalignant pain; long-term follow-up studies have shown that this effectiveness can be maintained; and effectiveness has been limited in many clinical trials by failure to
take into account high variability in dose requirements, failure to adequately treat depression, and
use of suboptimal outcome measures. Frequency of side effects in many RCTs has been inflated
by overly rapid dose titration and failure to appreciate the high interindividual variability in side
effect profiles. The recent marked increase in incidence of opioid overdose is of grave concern,
but there is good reason to believe that it has been somewhat exaggerated. Potential causes of
overdose include inadequately treated depression; inadequately treated pain, particularly when
compounded by hopelessness; inadvertent overdose; concurrent use of alcohol; and insufficient
practitioner expertise. Effective treatment of pain can enable large numbers of patients to lead
productive lives and improve quality of life. Effective alleviation of suffering associated with pain
falls squarely within the physician’s professional obligation. Existing scientific studies provide the
basis for many improvements in pain management that can increase effectiveness and reduce
risk. Many potentially useful areas of further research can be identified. Neurology® 2015;85:1–6

Filed under: General Problems