Chronic noncancer pain and opioids: Risks, benefits, and the public health debate.

Abstract

Psychologists involved with treatment teams deciding whether to pursue opioid pharmacotherapy for patients with chronic noncancer pain face a challenging dilemma. Although opioids offer a valuable treatment option for the millions of Americans who suffer from chronic pain, these medications also pose a significant risk for aberrant use among a subset of patients. The lack of clear information on this topic makes it difficult to determine how to proceed in professional practice. Notwithstanding empirical efforts to examine this complex issue, the prevalence rates of opioid abuse and dependence vary widely, and the accuracy in which the most popular assessment methods can predict aberrant use remains unclear. Furthermore, there is a paucity of data on the extent to which the long-term use of opioids can contribute to improvements in functioning and quality of life. The present paper highlights the key issues for this topic relevant to professional psychologists by reviewing the evidence regarding the benefits and risks associated with opioid use as a treatment for chronic pain and exploring areas of significant concern relevant to public health policy. At the current time, there are no simple solutions to this dilemma, and this review concludes with areas in need of further research in order to help clinicians make more informed decisions.