Opioids for chronic non-cancer pain

摘要: A 36 year old carpenter has a six month history of lower back pain with no specific clinical or radiological findings. As his not responded to paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), he asks doctor if can have “stronger painkillers” such as morphine. Opioids are group compounds that act by binding opioid receptors (μ, κ, δ), which widely distributed in the brain, spinal cord, peripheral tissues. They mainstay management cancer pain, but published data show continual increase volume prescribed opioids manage moderate severe, chronic, non-cancer pain.1 2 Changes attitude aggressive marketing driven dramatic use, more adverse events, including deaths from overdose (now second leading cause accidental death US).3 Proponents claim underused for chronic pain,4 lack good scientific prevented formulation evidence based guidelines their especially primary care. Several meta-analyses effectiveness been published. Most randomised trials summarised these were funded pharmaceutical industry report heterogeneous, short term outcomes highly selected patients. Non-randomised uncontrolled observational studies make up rest literature. Nevertheless, most consistently shown some reducing intensity. In particular, efficacy neuropathic pain,5 6 7 although regard only third line treatment because risk:benefit profile.8 9 The even less encouraging non-neuropathic focus this paper. 2009 Cochrane review 10 quasi-randomised controlled compared …