Rationale and Comments

Patients should be informed of the risks of such treatment, including the potential for addiction. Physicians and patients should review and sign a written agreement that identifies the responsibilities of each party (e.g., urine drug testing) and the consequences of non-compliance with the agreement. Physicians should be cautious in coprescribing opioids and benzodiazepines. Physicians should proactively evaluate and treat, if indicated, the nearly universal side effects of constipation and low testosterone or estrogen.

Sponsoring Organizations

• American Society of Anesthesiologists

Sources

• Expert consensus

Disciplines

• Neurologic

References

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• Atluri S, Akbik H, Sudarshan G. Prevention of opioid abuse in chronic non-cancer pain: an algorithmic, evidence based approach. Pain Physician. 2012 Jul;15:ES177–89.
  
• Colameco S, Coren JS, Ciervo CA. Continuous opioid treatment for chronic noncancer pain: a time for moderation in prescribing. Postgrad Med. 2009;121(4):61–6.
  
• Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D. Misuse of and dependence on opioids: study of chronic pain patients. Can Fam Physician. 2006;52(9):1081–7.
  
• Warner EA. Opioids for the treatment of chronic noncancer pain. Am J Med. 2012;125(12):1155–61.