Home Current Issue Previous Issues Published Ahead-of-Print For Authors Journal Info
Skip Navigation LinksHome > July/August 2008 - Volume 24 - Issue 6 > Efficacy of Opioids for Chronic Pain: A Review of the Eviden...
Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e31816b2f26
Special Topic Series

Efficacy of Opioids for Chronic Pain: A Review of the Evidence

Ballantyne, Jane C. MD, FRCA; Shin, Naomi S. BA

Collapse Box

Abstract

Opioid therapy for chronic pain has been popularized over the past few decades, and a concern has arisen that the analgesic efficacy of opioids is not always maintained over prolonged courses of treatment despite dose escalation and stable pain. Considering the potentially serious adverse effects of opioids, the idea that pain relief could diminish over time may have a significant impact on the decision to embark on this therapy, especially in vulnerable individuals. Possible loss of analgesic efficacy is especially concerning, considering that dependence may make it hard to withdraw opioid therapy even in the face of poor analgesia. This article first reviews the evidence on opioid efficacy when used for the treatment of chronic pain, and concludes that existing evidence suggests that analgesic efficacy, although initially good, is not always sustained during continuous and long-term opioid therapy (months to years). The theoretical basis for loss of analgesic efficacy over time is then examined. Mechanisms for loss of analgesic efficacy proposed are pharmacologic tolerance, opioid-induced hyperalgesia, subtle and intermittent withdrawal, and a number of psychologic factors including loss of the placebo component.

© 2008 Lippincott Williams & Wilkins, Inc.

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.