Opioids in chronic non-malignant pain

There's too little information on which drugs are effective and when

Primary care p 1154

The use of opioids in chronic non-malignant pain is profoundly messy. A simple start is to say that if somebody has severe pain which responds to opioids and for which there is no other effective remedy then why should they not receive opioids? Two judgments are then implicit: that opioids are effective and that other remedies are not. How well do these judgments hold up? And if they do, how do we work out which opioid and formulation? A paper in this week's issue addresses, but doesn't answer, the second question (p 1154).1

Opioids are often withheld to protect society or to protect the patient. The society argument is that the medical availability of opioid increases street addiction. There has never been any strong evidence that medical use increases street problems, and the introduction of oral morphine in Sweden in the early 1980s was shown not to increase addiction.2

Withholding the opioid to protect the individual might be done for physical or psychological reasons. Many notables across the centuries used opioids long term without deterioration in physical health: Florence Nightingale, …