The use of opioids in chronic musculoskeletal pain is increasingly common and is consistently recommended as second line pharmacological treatment in guidelines. However, opioid therapy for chronic non-cancer pain remains controversial. Effectiveness studies on the long term benefits and safety of opioid use are lacking and the epidemiological literature raises concerns about potential harms including greater disability, depression, lower quality of life, increased fractures and higher risk of overdose.
In the presence of such uncertainty, a pragmatic and functional approach to individual patient selection, titration, monitoring and discontinuation of opioids is recommended. When opioids do not result in the desired functional improvement, dose tapering and discontinuation alongside multidisciplinary non-pharmacological approaches to aid self-management may be more effective than dose escalation.
Disclosure of Interest J. Ashworth Speakers bureau: I have received honoraria for speaking at meetings sponsored by the following pharmaceutical companies, NAPP, Eli Lily & Pfizer