Opioids in the management of persistent non-cancer pain

The medical use of opioids to treat pain and illness predates historic record. Opioids have a well-defined role in the treatment of acute and cancer pain, and most clinicians are comfortable prescribing opioids in these contexts. However, in persistent non-cancer pain (PNCP) there remains considerable controversy. While there is evidence of short-to-medium-term benefit, concerns exist over long-term efficacy, side effects, safety, and the potential for opioid misuse. Guidelines published to date emphasize the importance of patient selection, opioid preparation, monitoring of therapy, and a multimodal treatment package including other disciplines and non-pharmacological therapies. Worldwide, the use of opioids for PNCP has increased significantly over the past decade and with it, concerns of increases in opioid-related harm.