Using opioids in general practice for chronic non-cancer pain: An overview of current evidence

Currow, DC; Phillips, J; Clark, K

Using opioids in general practice for chronic non-cancer pain: An overview of current evidence

Currow, DC

Phillips, J

Clark, K

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Publication Type:: Journal Article
Citation:: Medical Journal of Australia, 2016, 204 (8), pp. 305 - 309.e2
Issue Date:: 2016-05-02

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Field	Value	Language
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Phillips, J https://orcid.org/0000-0002-3691-8230	en_US
dc.contributor.author	Clark, K	en_US
dc.date.available	2016-03-10	en_US
dc.date.issued	2016-05-02	en_US
dc.identifier.citation	Medical Journal of Australia, 2016, 204 (8), pp. 305 - 309.e2	en_US
dc.identifier.issn	0025-729X	en_US
dc.identifier.uri	http://hdl.handle.net/10453/44764
dc.description.abstract	© 2016 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved. • Chronic non-cancer pain (lasting more than 3months) is highly prevalent in Australia (17% of males and 20%of females) and its optimal management is crucial to the health and wellbeing of the community. For 5% of the population, such pain interferesmarkedly with daily function. Part of the treatment for acute non-cancer pain for many people will include opioid analgesics at least for days to weeks. However, as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. • Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. • Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain: ► only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; ► consider referral to specialist services for assessment if doses are above 100mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; ► limit prescribing to only one practitioner; ► seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective.	en_US
dc.relation.ispartof	Medical Journal of Australia	en_US
dc.relation.isbasedon	10.5694/mja16.00066	en_US
dc.subject.classification	General & Internal Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Opioid-Related Disorders	en_US
dc.subject.mesh	Analgesics, Opioid	en_US
dc.subject.mesh	Drug Administration Schedule	en_US
dc.subject.mesh	Patient Selection	en_US
dc.subject.mesh	Primary Health Care	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Drug Prescriptions	en_US
dc.subject.mesh	Chronic Pain	en_US
dc.subject.mesh	Prescription Drug Misuse	en_US
dc.title	Using opioids in general practice for chronic non-cancer pain: An overview of current evidence	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	204	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	17 Psychology and Cognitive Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
utslib.copyright.status	open_access
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	204	en_US

Abstract:

© 2016 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved. • Chronic non-cancer pain (lasting more than 3months) is highly prevalent in Australia (17% of males and 20%of females) and its optimal management is crucial to the health and wellbeing of the community. For 5% of the population, such pain interferesmarkedly with daily function. Part of the treatment for acute non-cancer pain for many people will include opioid analgesics at least for days to weeks. However, as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. • Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. • Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain: ► only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; ► consider referral to specialist services for assessment if doses are above 100mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; ► limit prescribing to only one practitioner; ► seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective.

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http://hdl.handle.net/10453/44764