Chronic noncancer pain

Antoin H, Beasley RD. Opioids for chronic noncancer pain. Tailoring therapy to fit the patient and the pain. Postgrad Med. 2004 116 37 40,43-44. 

Dews TE, Mekhail N. Safe use of opioids in chronic noncancer pain. Cleve Clin J Med. 2004 71 897-904. 

McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain a systematic review. J Pain. 2003 4 231-256. 

Chronic pain is defined as a pain state that is persistent and for which the cause cannot be removed or otherwise treated and, in the generally accepted course of medical practice, no relief or cure is possible or none has been found after reasonable efforts. Chronic noncancer pain has been getting more attention in recent years— mandated attention. Examples of chronic pain include pain associated with arthritis, neuropathic pain (due to diabetes or other metabolic causes), pain that persists after an injury, and, the most common, low back pain. 

Guidelines for opioid use in chronic noncancer pain have been reviewed [8 ]. Adverse reactions or lack of effectiveness were mentioned as causes of dropouts in around 33% of patients in randomized trials. Opioids were also considered to improve functioning but not necessarily to improve quality of life. 

Stein C, Reinecke H, Sorgatz H. Opioid use in chronic noncancer pain guidelines... 

Sloots CE, Rykx A, Cools M, Kerstens R, De Pauw M. Efficacy and safety of prucalopride in patients with chronic noncancer pain suffering from opioid-induced constipation. Dig Dis Sci 2010 55 2912-21. 

Riley III JL, Hastie BA. Individual differences in opioid efficacy for chronic noncancer pain. Clin J Pain 2008 24(6) 509-20. 

During chronic therapy, especially for noncancer pain syndromes, the continued need for around-the-clock opioid therapy should be reassessed periodically (eg, every 6 to 12 months) as appropriate. 

During chronic therapy, especially for noncancer-related pain (or pain associated with other terminal illnesses), the continued need for the use of opioid analgesics should be reassessed as appropriate. 

---