PT  - JOURNAL ARTICLE
AU  - Meldon Kahan
AU  - Anita Srivastava
AU  - Lynn Wilson
AU  - Angela Mailis-Gagnon
AU  - Deana Midmer
TI  - Opioids for managing chronic non-malignant pain: safe and effective prescribing.
DP  - 2006 Sep 01
TA  - Canadian Family Physician
PG  - 1091--1096
VI  - 52
IP  - 9
4099  - http://www.cfp.ca/content/52/9/1091.short
4100  - http://www.cfp.ca/content/52/9/1091.full
SO  - Can Fam Physician2006 Sep 01; 52
AB  - OBJECTIVE To review the evidence on safe and effective prescribing of opioids for chronic non-malignant pain. QUALITY OF EVIDENCE MEDLINE was searched using the terms "opioid effectiveness" and "adverse effects." There is strong evidence that opioids are effective for both nociceptive and neuropathic pain, but limited evidence that they are effective for pain disorder. There is little information on their effectiveness at high doses or on the adverse effects of high doses. MAIN MESSAGE Opioids should be initiated after an adequate trial of acetaminophen or nonsteroidal anti-inflammatory drugs for nociceptive pain and of tricyclic antidepressants or anticonvulsants for neuropathic pain. Patients should be asked to sign treatment agreements and to give informed consent to treatment. Patients should experience a graded analgesic response with each dose increase. Titrate doses of immediate-release opioids slowly upward until pain reduction is achieved, and then switch patients to controlled-release opioids. Most patients with chronic non-malignant pain can be managed with<300 mg/d of morphine (or equivalent). CONCLUSION Opioids are safe and effective for managing chronic pain.