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Managing Chronic Pain with Opioids

At an evening symposium recently held in Sydney, Dr Michael A. Ueberall gave a presentation about the management of chronic pain with opioids, with a focus on the chronic low back pain. Dr Ueberall is Vice President of the German Pain Association and pain specialist at the Institute for Neurological Sciences in Nürnberg, Germany.

Dr Ueberall’s talk highlighted the definitive place that opioid analgesics still hold in the treatment of chronic non-malignant pain. He advised, however, that opioid therapy should always be utilised as part of a multimodal treatment approach that encompasses other pharmacological and non-pharmacological measures.

Approximately two-thirds of patients with chronic non-malignant pain will experience improvements in pain, pain-related disability in daily life, and quality of life, if they undertake a multimodal treatment method that includes opioids.

However, around 50 to 70 percent of opioid-treated patients also experience constipation as a direct side effect. It is a frequent and distressing complication of potent opioid analgesic therapy. Opioid-induced bowel dysfunction (OIBD) may develop as a comorbidity in patients with chronic non-malignant pain, and may negate the success of treatment regarding pain, functionality, and quality of life. Conventional treatments of OIBD, such as laxatives, are often prescribed despite limited evidence of efficacy.

Dr Ueberall asserted that opioid analgesics are effective in the treatment of refractory neuropathic pain, but are often not recommended because of their adverse side-effects (such as constipation) and safety considerations. He proposed that safety can be improved if opioids are carefully titrated as part of a multimodal strategy to meet the needs of individual patients.

(2017) Prescribing opioids — balancing efficacy and tolerability when treating patients with chronic noncancer pain. Research Review (Speaker Series). Geelong, Victoria, Australia.

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