Opioid Abuse in Chronic Pain--Misconceptions and Mitigation Strategies.

  title={Opioid Abuse in Chronic Pain--Misconceptions and Mitigation Strategies.},
  author={Nora D. Volkow and A. Thomas Mclellan},
  journal={The New England journal of medicine},
  volume={374 13},
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction. Given… 

Figures and Tables from this paper

Time for nonaddictive relief of pain

Although indispensable for managing acute severe traumatic pain and pain in a palliative setting, most opioids are prescribed either by dentists or by primary practitioners for chronic nonmalignant pain, and marketed aggressively to consumers for the latter, despite no scientific evidence supporting such treatment beyond 12 weeks.

Treating Acute Pain in the Opiate-Dependent Patient

  • Coleen Dever
  • Medicine
    Journal of trauma nursing : the official journal of the Society of Trauma Nurses
  • 2017
The purpose of this literature review is to provide resources to treat pain, given a tolerant opioid-dependent patient.

Opioids May be Appropriate for Chronic Pain

  • P. Christo
  • Medicine, Psychology
    Journal of Law, Medicine & Ethics
  • 2020
This paper will examine opioid therapy in the setting of the opioid epidemic, why critics feel that the CDC guideline has resulted in harsh consequences for patients and their physicians, and the rationale for opioid therapy as a means of providing ethical and compassionate pain care.

Inpatient Pain Management in Patient with Opioid Use Disorder

Acute pain management in patients with chronic opioid users is best managed by a multimodal approach using medications such as ketamine, lidocaine infusions, dexmedetomidine and regional anesthetic techniques.

Pain Relief in Persons with Substance Use and Addictive Disorders

The underlying mechanisms of addiction and how these interact with various pain syndromes are explored and the analgesic response to medications and appropriateness for opioids, in particular, is varied but predictors can help determine treatment.

Chronic Noncancer Pain and Opioid Addiction: Diagnostic and Management Challenges

The patient was diagnosed to be suffering from opioid dependence syndrome with depressive episodes, for which she was provided tablet buprenorphine 14 mg/ day dose along with tablet sertraline 150 mg/day.

Confronting the Opioid Crisis: Practical Pain Management and Strategies: AOA 2018 Critical Issues Symposium.

Clinicians need to understand the pathophysiology and science of addiction to improve perioperative management of pain for their patients and changes to policy that improve provider education, access to naloxone, and treatment for addiction can decrease narcotic misuse and the risk of addiction.

Challenges and concerns of persistent opioid use in cancer patients

Despite extensive availability of opioids and related common adverse consequences, including the potential for escalating use, abuse, and deaths, greater awareness is needed to counteract the present atmosphere and appropriately manage patients with chronic cancer pain.

Medical Devices to Prevent Opioid Use Disorder: Innovative Approaches to Addressing the Opioid Crisis

The need to treat pain effectively with opioids must be balanced by a sensitivity to an increased risk of OUD, and ways in which “medical devices” could be used to prevent OUD are discussed.

Risk Management for Opioid Prescribing in the Treatment of Patients With Pain From Cancer or Terminal Illness: Inadvertent Oversight or Taboo?

Limited guidance exists for prescribers of opioids to treat pain in patients with cancer or terminal illness and palliative care and hospice programs appear poorly prepared for assessing or managing patients with aberrant behaviors or evidence of drug abuse.



Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment.

Suggestions should be considered for improving current noncancer pain management in primary health care settings that could decrease diversion, abuse, and overdose of opioid medications.

Suicide by Means of Opioid Overdose in Patients with Chronic Pain

Although most opioid prescribing tools focus on identifying risk factors for potential abuse, diversion, and propensity for opioid addiction, physicians who consider prescribing opioids should also screen and optimize chronic pain treatment for patients at risk for suicide.

Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction

Context Patients with low back pain often request pain medication, and many physicians prescribe opioids despite concerns about drug dependence. Contribution Opioid prescribing rates in 11 studies

Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain.

Primary care physicians believed training is essential to learning about the risks involved with chronic pain and opioid dependence, but many of them evaluated their own medical training in these areas as unsatisfactory.

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia.

The authors find that certain clinical characteristics are often used by practitioners to make differential diagnosis of OT and OIH despite some overlap in their clinical presentation, and a key difference in clinical outcome is that OT and NLP could be improved and exacerbated by opioid dose escalation, respectively.

Depression, chronic pain, and suicide by overdose: on the edge.

Recommendations for the use of validated and practical screening tools as part of a comprehensive clinical assessment and for approaches to suicide prevention and interventions as crucial components of chronic pain management are outlined.

Opioid Formulations Designed to Resist/Deter Abuse

Three new formulations of opioid analgesics designed to resist or deter abuse are examined, which hold individual promise, but it remains undetermined if they can truly prevent abuse.

Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain

The objective of the current study was to systematically search for and evaluate the quality of guidelines addressing the use of opioids for chronic pain, and compare guidelines recommendations related to mitigating the risk for accidental overdose and misuse.