Abstract
Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of opioids is prominent in patients with chronic back pain and early recognition of misuse risk could help physicians offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this review, we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic back pain and present an overview of assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic back pain have significant medical, psychiatric and substance use comorbidities that affect treatment decisions and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no “gold standard” for opioid misuse risk assessment, several validated measures have been shown to be useful. Controlled substance agreements, regular urine drug screens, and interventions such as motivational counseling have been shown to help improve patient compliance with opioids and to minimize aberrant drug-related behavior. Finally, we discuss the future of abuse-deterrent opioids and other potential strategies for back pain management.
Highlights
Chronic back pain negatively impacts every facet of daily living
One study suggested that opioids and NSAIDs may aid short-term pain relief in patients with low back pain; stopping treatment may cause an increase in symptoms [31]
Comprehensive assessment and monitoring is recommended for all patients who are on long-term opioid therapy for chronic back pain
Summary
Chronic back pain negatively impacts every facet of daily living. Chronic back pain, defined as pain that lasts longer than 6 months, has been seen to interfere with individual’s quality of life, by interrupting sleep, employment, social functioning, and many other daily activities. Opioid analgesics have been used to help manage acute as well as cancer-related pain [13] This class of prescription medication is used as a treatment for individuals with chronic noncancer back pain; many physicians are reluctant to prescribe opioids for these patients since this medication contributes to adverse effects, tolerance, and addiction [14]. We review opioid abuse and misuse issues that often arise in the treatment of patients with chronic noncancer back pain and discuss assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. The intent of this review paper is to provide a brief overview of studies on the assessment and treatment of abuse risk on opioid prescribing for chronic noncancer pain. The paper is divided into the following subsections: (1) definition of terms, (2) adverse effects of opioid therapy, (3) medical comorbidity among pain patients, (4) initial medical assessment, (5) psychiatric comorbitidity, (6) substance abuse assessment, (7) urine toxicology screens, (8) opioid therapy agreement, (9) abuse-deterrent opioids, (10) interventions for high-risk patients, and (11) future considerations
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