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Issues in Opioid Management

Bloodworth, Donna MD

American Journal of Physical Medicine & Rehabilitation: March 2005 - Volume 84 - Issue 3 - p S42-S55
doi: 10.1097/01.PHM.0000154907.30010.1B
Review & Analysis: Chronic Pain
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Bloodworth D: Issues in opioid management. Am J Phys Med Rehabil 2005;84:S42–S55.

Although a universal consensus has evolved concerning the utility of opioids in cancer pain, the use of opioids for the treatment of chronic nonmalignant pain syndromes is much debated in the medical literature. Although for clinical, regulatory, and medicolegal reasons, many clinicians disagree with their use, others find them helpful, with little prevalence of abuse behaviors or intolerable adverse effects. In a review of this topic, several issues of relevance to management decisions, including efficacy, medication compliance, and safety, are evaluated. As a clinically distinct population among chronic pain sufferers, patients with arthritis-associated pain (including rheumatoid and osteoarthritis) are discussed separately. Particularly important issues with regard to prescribing decisions, including divergent goals and expectations, and factors associated with avoidance of withdrawal and addiction, are also evaluated to ensure that management of patients with nonmalignant chronic pain is optimized when opioids are considered.

From the Department of Physical Medicine and Rehabilitation, Quentin Mease Hospital, Houston, Texas.

All correspondence and requests for reprints should be addressed to Donna Bloodworth, MD, 3601 North MacGregor, Room 240B, Houston, TX 77004.

© 2005 Lippincott Williams & Wilkins, Inc.