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Author | Edgar L. Ross, MD


Chronic pain update: Addressing abuse and misuse of opioid analgesics

Opioid analgesics provide effective treatment for noncancerpain, but many physicians have concerns about adverse effects,tolerance, and addiction. Misuse of these drugs is prominentin patients with chronic pain. Recognition and early prevention ofmisuse helps physicians identify the causes and proceed with patientcare. Most persons with chronic pain have a significant medicalcomorbidity (eg, asthma) that affects treatment decisions. All patientsshould undergo an initial comprehensive evaluation. Patientsoften have a psychiatric comorbidity, such as depression or anxiety.There is no gold standard for risk assessment, but several traditionalmeasures may be used. Pain medicine practitioners increasingly areusing urine drug screens to monitor adherence to long-term opioidtherapy. Controlled substance agreements help improve patient compliance.(J Musculoskel Med. 2008;25:268-277, 302)