Abstract
Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this shift within pain medicine, and an emphasis was placed on developing reliable and valid methods and measures of identifying those at risk for opioid misuse. Since that time, the evidence for the safety and effectiveness of chronic opioid therapy (COT) has not been established. Rather, the harmful, dose-dependent deleterious effects have become clearer, including addiction, increased risk of injuries, respiratory depression, opioid induced hyperalgesia, and death. Still, many individuals on low doses of opioids for long periods of time appear to have good pain control and retain social and occupational functioning. Therefore, we propose that the question, “Who is at risk of opioid misuse?” should evolve to, “Who may benefit from COT?” in light of the current evidence.
Highlights
Beginning at the turn of the millennium, questions arose about the under-utilization of opioid pain medication to treat individuals suffering from chronic noncancer pain (CNCP) [1]
Measures such as the Pain Medication Questionnaire (PMQ) [4] and The Screener and Opioid Assessment for Patients with Pain (SOAPP) [5] were developed, as well as guidelines for urine drug testing, to identify those who were at risk of misusing their opioids or to determine who was engaging in aberrant, and potentially harmful, opioid use
We propose that the question should evolve from, “Who is at risk for opioid misuse?” to, “Who may benefit from chronic opioid therapy (COT)?” given the current evidence for this intervention
Summary
Beginning at the turn of the millennium, questions arose about the under-utilization of opioid pain medication to treat individuals suffering from chronic noncancer pain (CNCP) [1]. Terms such as “opiophobia” became used more widely and referenced a potentially irrational fear that providers had with regard to utilizing this class of medication [2]. We propose that the question should evolve from, “Who is at risk for opioid misuse?” to, “Who may benefit from COT?” given the current evidence for this intervention
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