Opioids and Chronic Noncancer Pain: Clinical Challenges
Despite the controversy raised by the practice of prescribing opioids to relieve chronic non-cancer related pain (CNCP), a medical problem which is often resistant to conventional medical treatment, the popularity of this class of medications has increased in the last decade. While some physicians are still reluctant to prescribe opioids, others prescribe them without regard to the potential deleterious effects they can have on patients. This article reviews the metaanalysis and systematic reviews on the use of opioids in CNCP published in the last fifteen years. After highlighting methodological considerations, the principal results are presented with respect to the effectiveness of opioids, their side-effects and the risk of addiction. Recommendations geared toward a safe follow-up of patients receiving opioids are then formulated. Finally, the decision whether to prescribe or not to prescribe opioids for the treatment of CNCP is analyzed within a global framework, in light of the physician’s objective to relieve pain, the patient’s objective to remain an active member of society as well as the ethical objective to keep the medicine from becoming an addictive drug.