Opioids for chronic musculoskeletal pain: Putting patient safety first

A Neurobehavioral Approach to Addiction: Implications for the Opioid Epidemic and the Psychology of Addiction

“…A Danish epidemiological study evaluating the effects of long-term (> 6 months) opioids in more 10,000 patients with chronic noncancer pain failed to show improvement in any of the items in the Short Form Health Survey (SF)-36 (Tarlov et al, 1989) scoring of health-related quality of life, relative to time zero and to people who do not use opioids for pain (Eriksen, Sjøgren, Bruera, Ekholm, & Rasmussen, 2006). Some evidence suggests that return to work is more often delayed than expedited for patients receiving opioids for the long term (Von Korff, 2013). Today, despite the existence of a number of opioid compounds and formulation, no evidence exists that suggests one opioid analgesic is superior to another in its ability to manage acute or chronic pain.…”

Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing

“…1, 2 As a result, there is an urgent need to better understand patterns of opioid prescribing. Our prior work demonstrated that 12% of the population of Olmsted County, MN received a new prescription for opioids in 2009; opioids were the third-most frequently prescribed drug in this geographically-defined population which included both insured and uninsured patients.…”

Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing

“…The type of pain being treated was primarily musculoskeletal in origin with back, neck, limb and joint pain the most frequently recorded indications for the use of a strong opioid. The lack of evidence for the use of opioids in musculoskeletal pain 5,43,44 indicates potentially inappropriate prescribing and may lead to dose escalation if the lack of efficacy is put down to insufficient dose.…”

“…Long-term opioid prescribing for the management of chronic pain conditions has increased substantially in the last 20 years, [1][2][3][4] with one paper suggesting that global opioid prescribing has increased 30-fold over the period 1980-2010. 5 Chronic opioid therapy (COT) prescribing has resulted in an epidemic of opioid-induced morbidity and mortality, particularly in the United States. [6][7][8] A notable editorial published immediately prior to this work attested to the national UK concern associated with opioid prescribing.…”