Opioids and Chronic Pain: Where Is the Balance?

Abstract

Chronic opioid therapy (defined as greater than 3 months on opioids) is a common practice for those with non-cancer pain, cancer survivors with treatment-related pain, and individuals with cancer undergoing disease-modifying therapy with a survival that can be for a year or more. Recent studies have found unique long-term toxicities with opioids which reduce the utility of opioid therapy in chronic pain. The risk of addiction, depression, central hypogonadism, sleep-disordered breathing, impaired wound healing, infections, cognitive impairment, falls, non-vertebral fractures, and mortality are increased in populations on long-term opioids. Factors associated with these risks are related to dose, duration of opioid therapy, type of opioid, and formula (long-acting, short-acting). This state-of-the-art review discusses the risks and benefits of chronic opioid therapy and strategies to increase utility and diminish risks to opioid therapy.

Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy

“…Other symptoms occurring in the palliative community are often managed with opioids and steroids, which could cause cognitive impairment. 13,14 A knowledge gap was identified among interprofessional palliative health care team participants. PRT was frequently not recognized as a treatment option that can reduce the need for drugs and their corresponding side effects.…”

Recent advances in understanding and managing cancer pain

“…This is especially important in the context of longer survival in cancer and improving cure rates. Many cancer patients and cancer survivors require chronic opioid therapy (COT) (defined as greater than three months) which has been associated with increased risk of endocrinopathies, depression, sleep-disordered breathing, impaired wound healing, substance use disorders, and cognitive impairment 9, 35 . Finding the proper balance between appropriate analgesia and minimizing the risks of associated with COT is often quite challenging.…”

“…Patients with cancer are now exposed to many therapies (some of them relatively new, such as immunotherapy) over relatively long periods of time. Many of these therapies carry a risk of considerable side effects, including pain 9, 10 .…”

Pc-Facs

“…In addition, there is a growing awareness of the risk associated with LTOT. 6 However, there are no well-defined guidelines that would help clinicians taper opioids, especially in primary care settings. This systematic review excluded studies involving acute pain, cancer pain, or those that involved only palliative or hospice care.…”