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Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions

Ballantyne, Jane C. MD, FRCA

doi: 10.1213/ANE.0000000000002500
Chronic Pain Medicine: Special Article

An overreliance on opioids has impacted all types of pain management, making it undoubtedly a root cause of the “epidemic” of prescription opioid abuse in the United States. Yet, an examination of the statistics that led the US Centers for Disease Control and Prevention to declare that prescription opioid abuse had reached epidemic levels shows that the abuse occurrences and deaths are arising outside the hospital or hospice setting, which strongly implicates the outpatient use of opioids to treat chronic pain. Such abuse and related deaths are occurring in chronic pain patients themselves and also through diversion. Overprescribing to outpatients has afforded distressed and vulnerable individuals access to these highly addictive drugs. The focus of this article is on what we have learned since opioid treatment of chronic pain was first popularized at the end of the 20th century and how this new information can guide chronic pain management in the future.

Supplemental Digital Content is available in the text.

From the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.

Accepted for publication August 18, 2017.

Funding: None.

The author declares no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the author.

Address correspondence to Jane C. Ballantyne, MD, FRCA, Department of Anesthesiology and Pain Medicine, Box 356540, University of Washington School of Medicine, Seattle, WA 98195. Address e-mail to

© 2017 International Anesthesia Research Society
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