Therapy of chronic non-malignant pain with opioids.

Abstract

To the Editor: We read with interest the paper by Mak et al.1 concerning the use of methadone and tramadol for chronic pain in an actively employed police officer. It is well established that the use of potent opioid medications in chronic non-cancer pain is appropriate and comprises good clinical care. Several Canadian provincial Colleges of Physicians and Surgeons and the Canadian Pain Society have published guidelines for such use2 as well as those noted in this report. What we think is unique and important in this report are that works reports were prepared regularly by this officer’s employer for performance analysis. This individual was able to return to and function effectively in a demanding position. To our knowledge this is the first report of this type of evaluation in an individual using opioids for chronic noncancer pain. This finding lends support to what we frequently see in clinical practice; patients who are prescribed opioids for chronic non-cancer pain can and do return to productive life styles with control of their pain and with minimal impairment in psychomotor functioning. Zacny has reviewed the effects of opioids in opioid dependent users on psychomotor and cognitive functioning and shown little effect.3 The same is true for the driving ability of individuals with cancer pain who are treated with opioids.4 Within the patients followed at our pain management unit we have more than 20 who use the equivalent of 300 mg or more of morphine per day, who lead productive lives and are able to perform everyday activities safely, such as driving. Some also continue to hold fulltime positions effectively. The use of an opioid on a chronic basis can be safe and effective.