Principles & Practice of Pain Medicine > Part VI. Pain Therapies > A. Pharmacologic Treatments > Chapter 59. Opioids for Nonmalignant Pain: Issues and Controversy Craig L. Shalmi

Opioids for Nonmalignant Pain: Issues and Controversy: Introduction

"This chapter discusses the use of opioids in the treatment of chronic nonmalignant pain and focuses in on the vehement controversy that this subject continues to generate. The use of opioids has become well established for the treatment of cancer pain and acute pain.^1–3 However, opioid use for chronic nonmalignant pain has been generally regarded as unsafe and ineffective until this past decade. More recently, these views have undergone a reappraisal driven by a number of factors, including a mounting realization that pain remains drastically undertreated. Investigations into the incidence of unrelieved pain and suffering in the United States and throughout the world prompted the National Institutes of Health to designate chronic pain as one of the most significant public health problems facing medicine.⁴ It is estimated to affect over 50 million Americans, and it is the presenting complaint in 80% of physician visits.⁵ The cost to our society of this pain and suffering, whether measured by its deleterious effect on people's lives or in dollars and cents, is incalculable.The perception that some physicians are insensitive to their patient's pain is probably rooted in a number of realities: The first of which is that chronic pain can be difficult to treat. Beyond opioids, physicians lack medications that yield a high degree of efficacy in severe pain states. So, ultimately, it is not so much the case that physicians neglect treating pain as they are reluctant to prescribe opioids. This reluctance..."