Opioids for persistent non-cancer pain

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7484.156 (Published 20 January 2005) Cite this as: BMJ 2005;330:156
  1. Eija Kalso, professor of pain research and management (eija.kalso@helsinki.fi)
  1. University of Helsinki and Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, FIN-00029 HUS, Finland

    A team approach and individualisation of treatment are needed

    Epidemiological studies from Australia and Denmark indicate that about 19% of the population is afflicted by chronic pain that is not caused by cancer.1 2 The prevalence of chronic pain that interferes with daily activities is 12.6%.1 In most Western countries, opioids are established in treating pain due to cancer, and they are increasingly used to manage chronic pain not due to cancer. Opioids are effective analgesics, but they also have a strong reinforcing potential—fear of addiction and diversion restrict their medicinal use. Good clinical trials, guidelines, and responsible prescription are needed to ensure the availability of opioids for those patients who may benefit.3 4

    A recent systematic review included 11 randomised and controlled trials on oral opioids in non-cancer pain.5 The review showed that opioids provided pain relief for both neuropathic (postherpetic neuralgia, diabetic neuropathy) and musculoskeletal pain (osteoarthritis). Large differences between individuals in the response to …

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