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Prevention and management of side effects in patients receiving opioids for chronic pain

Russell K Portenoy, MD
Zankhana Mehta, MD
Ebtesam Ahmed, PharmD, MS
Section Editor
Janet Abrahm, MD
Deputy Editor
Diane MF Savarese, MD


Opioids represent a mainstay for treatment of severe chronic pain in patients with active cancer or other serious chronic illnesses. Although the side effect liability of these drugs is significant and they are inherently associated with the serious problems of drug abuse and addiction, experience in the management of cancer pain indicates that they can potentially be used safely and effectively for all types of pain (ie, somatic, visceral, neuropathic). (See "Cancer pain management with opioids: Optimizing analgesia" and "Cancer pain management: General principles and risk management for patients receiving opioids".)

The term “chronic non-cancer pain” is ill defined but generally understood to apply to common types of musculoskeletal pain syndromes, such as arthritis and low back pain, and to headache. The long-term use of opioid drugs for these conditions is more controversial. For patients with chronic non-cancer pain, the decision to begin opioid therapy must be weighed carefully. (See "Use of opioids in the management of chronic non-cancer pain" and "Overview of the treatment of chronic non-cancer pain".)

A trial of an opioid for long-term use may be considered when:

Other alternative therapies have not provided sufficient pain relief and

Pain is adversely affecting a patient’s function and/or quality of life and


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Literature review current through: Aug 2017. | This topic last updated: Aug 18, 2017.
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