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Long-Acting Opioids for Chronic Pain: Pharmacotherapeutic Opportunities to Enhance Compliance, Quality of Life, and Analgesia

McCarberg, Bill H. 1*; Barkin, Robert L. 2

American Journal of Therapeutics: May-June 2001 - Volume 8 - Issue 3 - p 181-186
Therapeutic Reviews

Effective management of chronic pain has become an increasingly critical issue in health care. Opioid agonists are among the most effective analgesics available for reducing pain perception; however, their chronic use is controversial. This is primarily due to regulatory barriers, misunderstandings about pain management among primary caregivers, fear of adverse side effects, and misconceptions about the potential risks of addiction. Short-acting opioids provide effective analgesia for acute pain but should be avoided as primary analgesics for chronic pain management. Long-acting opioids have greater utility than short-acting opioids in treating chronic pain in patients with consistent pain levels. Results of studies show that improved quality of life is directly related to the use of long-acting opioids in patients with chronic pain of both cancer and noncancer etiology. Short-acting opioids may be used during the initial dose titration period of long-acting formulations and as rescue medication for episodes of breakthrough pain. Clinical experience reveals that selection of an effective pain regimen for the patient with chronic pain, combined with aggressive management of side effects, leads to improved overall functioning and quality of life.

1 Director of the Chronic Pain Management Program and Coordinator of Pain Services, Kaiser Permanente, San Diego, CA; Coordinator of Family Practice, Kaiser Permanente, Escondido, CA; Assistant Clinical Professor (voluntary), University of California at San Diego School of Medicine.

2 Clinical Pharmacologist, Rush Pain Center of Rush–Presbyterian–St. Luke's Medical Center, Chicago, and Rush Northshore Hospital, Skokie, IL; Associate Professor of Anesthesiology, Family Medicine and Pharmacology, Rush Medical College, Chicago, IL.

*Address for correspondence: 732 North Broadway, Escondido, CA 92025, USA; e-mail:

© 2001 Lippincott Williams & Wilkins, Inc.